1. #1
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    Unhappy What do I do, how do I deal with this??

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    ... To be brief, my first code that I work on dies, and i cant get this out of my head. I have a hard time sleeping, and when I do, the victim seems to show up in my dreams....I cant deal with this, how can I make this stop?? I am supposed to start Fire Standards at the beginning of Oct, but now im not even sure if I want to stay in Fire-EMS???
    Last edited by WebTeam; 09-11-2005 at 05:20 PM.
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    You need to talk to someone who can help you work through your feelings. Remember you did what your training taught you, and that's all you can do. Not every patient is going to be saved, sometimes people die no matter what we do to help them. I'm thinking that a big part of the reason why this is bothering you so much is because of the age of the patient. I strongly encourage you to seek out someone to speak to and work through this with. I wish you the best of luck and remember we are all here for you.
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    it should be noted that alothough I am a NJEMT and worked in South Jersey, I live in Central Fla, and I have a hard time talking to my "family" at the park, or the CISD Chaplin who came to talk to us after the incident. Is there other people to talk to, even though I am out of state?
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    I had just come back from vacation there and been on the same slide where that happened. It's tragic and very sad, but I think what you will eventually realize is that unless you watched her go under there is nothing you could do. Everybody has a job they wish went another way or that made them realize that things don't go exactly as described in EMT class. I took my CPR instructor class with group of school teachers a number of years ago. I was the only fire/ems person in the room. The teachers were all very interested in my experience with CPR and how many lives I had saved. The answer was very few per my number of attempts which may have brought some reality to what they were learning, but I do CPR correctly, follow the protocols and people still die. We can only stress over the things that are within our ability to change.

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    Try to talk to someone about it, begin to think in logical terms. Unfortunatly many EMT's and Paramedics get into this mode that NO ONE should die in their care. Sadly, this isn't the case.

    Try to remember, people can and will die in your care, the difference is if you did what you feel you could to help the person. Someone else was there immediately to help, you tried to assist, ALS personnel I am assuming took over the code and worked it to the best of their abilities as well.

    Try to work through it, understand that people, even children die. Watching a child die of any age is tough even for people who have been doing EMS for years. Turn a negative into a positive and use her death for reinforcement of your skills and bettering yourself.

    Hope some of this helps.
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    Talk. The only way to get through it.

    That being said, one thing that is lacking in many EMS training courses is the dismal anount of "saves" that actually come about by CPR.

    Even in the best systems, CPR is only effectively going to "save" a patient in about 15% of cases. A very large percentage of them go on to die in the hospital. The percentage that actually leave the hospital as if nothing had happened is miniscule. The remainder of patients require rehabilitation of some sort - regardless of age of the patient.

    The first one is always the hardest. Pedi codes will always wear on you, regardless of how long ago they were, or what you go on to do in life. Everyone handles it differently, and you are no less a person for it bothering you. You are no less an EMT for it bothering.

    You must seek help if it is bothering you this long after the incident. Whether it be with clergy, a private counselor, or a public safety specialist like CISD team. You need to care for yourself before you can care for others.
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    Default Thoughts....

    I have been a FF for 14 years and a Paramedic for 13. I have taught both for the last 8 at a local community college so I see a lot with students, especially EMS after a "ride".

    Here's what I tell them......... (kinda long but worth reading)


    While this job is about saving lives, it is the ones we lose that sometimes remain with us the most. Saves are few and far between and should be treasured by each of us. The ones we don't save, while saddening, are a part of the overall process. Take the loss of the patient as a learning tool for your future patients. Look at what went right and then look at what went wrong. How can we be better next time? These are some questions you many have already asked yourself but this time revisit them from the true "learning" aspect. And don't ever forget, we don't make the plan, we just play the game. I believe and put my trust in God. It just wasn't in "the plan" and I always believe if I wasn't meant to save the patient, then I was meant to learn from the patient and they had an appointment with the big guy upstairs. Now does this help the hurting right now, well no probably not. Talking to someone is always helpful. Some good sources for guidance are a fellow responder who "has been there", your priest/minister/pastor/rabbi, your mentor in the field, a CISD member, or a licensed therapist. If you choose not to talk to others, then you must learn to talk to and heal yourself which is very difficult. And finally, look within yourself and make that decision. Is this really what you want to do for a living? This is how the career goes. The one that you feel we should save, we lose a majority of the time. The calls that go absolutely horrible amazingly enough produce saves. God's hand, not yours.

    Hope you find your peace brother!

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    POST EDITED TO REMOVE PERSONALLY IDENTIFIABLE INFORMATION
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    If you are personally involved in some sort of case that could involve legal action or otherwise, the LAST thing you want to do is discuss it in public forum and provide this many details. We've edited out the parts that discussed the specific incident.

    Otherwise, the discussion on how to seek counseling, etc. is fine.

    Thanks
    WebTeam
    Last edited by WebTeam; 09-11-2005 at 05:21 PM.

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    Yeah, HIPPA violations cost a lot of cha ching. Nevermind the inevitable useless ambulance chaser that has probably already contacted the family.
    "Too many people spend money they haven't earned, to buy things they don't want, to impress people they don't like." Will Rogers

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    To be honest with you if its bothering you already its probably something that you should no do anymore. It could get better or it could get worse. A friend of mine who was a paramedic for a couple of years was fine with all the calls up until he went to a report of a gunshot wound with pd on the scene. Well needless to say pd wasnt on the scene and the gun shot wound didnt happen yet. The 15yr old kid was sitting on the side of the porch and waited for the medics to get close enough to see him and then shot himself in the head.

    It really messed him up for a long time(and still some today).


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    Quote Originally Posted by cdemarse
    To be honest with you if its bothering you already its probably something that you should no do anymore. It could get better or it could get worse. A friend of mine who was a paramedic for a couple of years was fine with all the calls up until he went to a report of a gunshot wound with pd on the scene. Well needless to say pd wasnt on the scene and the gun shot wound didnt happen yet. The 15yr old kid was sitting on the side of the porch and waited for the medics to get close enough to see him and then shot himself in the head.

    It really messed him up for a long time(and still some today).


    If its not what you want to do get out. There is no shame in it.
    I honestly don't think he should let his first death force him out of this line of work. I think that is bad advice, because this could still haunt him even if he did leave the job. He needs to seek counseling, wether its defusing with his peers or a CISD session or even just a meeting with a chaplain, or someone else that can give him guidance.

    There are good things with every job, while you may lose some of the people in this line of work (including children) there are many rewarding calls, including those when you DO save someone's life or when you get a thank you from someone. Those tend to make a lot of things better.
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    Quote Originally Posted by cdemarse
    To be honest with you if its bothering you already its probably something that you should no do anymore. It could get better or it could get worse. A friend of mine who was a paramedic for a couple of years was fine with all the calls up until he went to a report of a gunshot wound with pd on the scene. Well needless to say pd wasnt on the scene and the gun shot wound didnt happen yet. The 15yr old kid was sitting on the side of the porch and waited for the medics to get close enough to see him and then shot himself in the head.

    It really messed him up for a long time(and still some today).


    If its not what you want to do get out. There is no shame in it.

    I wouldn't suggest this, he's having a difficult time as it is...you need to not scare him any further.


    BLSboy, okay, you've been through somthing that has really messed with your head. In the profession you've chosen it's going to happen. The first one is always the toughest. EMS is a dirty, ugly profession, and you ARE going to have your demons, but you need to confront them, and deal with them in what ever manner you want. If it's hard to talk about, then don't talk about it. I've been on some very ugly car accidents, traumas, etc..how do I deal with it? I know I can't save everyone, and there are some, well many things I cannot control. While I don't want to lose people, it's the nature of the beast, take comfort in knowing those that cannot be saved are more than likely in a better place. I don't preach religeon, but I do belive there is a reason for everything, and that there is a plan for everyone, even if it's one we may not agree with...

    In the end..stick with it, the job will reward you in many, many ways.
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    Quote Originally Posted by DaSharkie
    That being said, one thing that is lacking in many EMS training courses is the dismal anount of "saves" that actually come about by CPR.
    When I got my FA/CPR renewed last time, our instructor did mention it. I hadn't heard the stats before but they did surprise me. However, it did sort of center what we were learning into reality - i.e., you need to try everything you can, and that's all good; however the majority of CPR recipients don't make it, and that is a fact of trying to save a life. It doesn't mean you did it wrong, or shouldn't try again, it's just the way things go. If you save the life, be proud because it doesn't happen as often as TV would have you think. If you don't, try not to place personal guilt for it.

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    What is a "code".The end of life as we know it.Take no action,the outcome is certain.The ONLY chance for a patient that has coded is take action.Do you always win. NO! But your action means at least you gave it your best shot.Seek out help from somebody to help you sort it out be it a peer group,advisor,chaplin. T.C.

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    CISD is NOT for sissies or those that can't hack it on this job.It's for dealing with stressful incidents that do not get filed away properly so you can choose when and how you revisit them.
    Losing a patient happens.It comes with the job and if you can't deal with it,there are sources to help you deal with it as best as you can.Try them before you decide that you aren't cut out for this line of work.It might be that since it's your first,you are spending more time than you need to on the past and will leave a job that you CAN handle.
    I think you'd have to be crazy NOT to get upset over losing a patient .But don't let it stop you from learning to better yourself as an EMT.You put a lot of time and effort into getting trained so I doubt that you'll want to throw that away over the first loss you experience.
    Learn from it,find out how your friends can help you deal with it and THEN you can decide if you want to leave the fire/EMT service.

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    BLSboy: Like others have said here, you are going to be the person that has to figure out how to deal with this. Don't think that your feelings make you any less a provider. As rforsythe said, his CPR instructor did mention in their last class the "odds" of someone surviving sudden cardiac arrest. We all know that percentage is WAY low, but yet we still have to try and do what we can, with the hope that someday, sometime it will make a difference. I dont really preach any kind of religion, but sometimes I think that things happen for a reason and we have absolutely no control over. We cant change anything, and we have to accept that. It doesnt mean we have to like it, just have to be able to deal with it. Don't let this one call put a damper on your time in EMS. You are entering a very noble career, that has far more benefits then you can see now. Yeah, they may not be that glorious, but as they happen, you will know. Get some help, whether it be from CISD (whether you agree on that or not...) or even get some professional help. There is nothing wrong with getting professional help. I think too many people think they don't need it and there are alot of benefits from it. Talk to you fellow providers. Some of them who have been around a while may be able to help you. I live in a community (relatively small compared to thers) where I have lived my entire life. Probably over 70% of my calls involve people that I know here in my community. And yes it hurts like hell when you code your neighbor, or your friends mom/dad or whatever. We have to live with that in small towns. You have to find the way to deal with it. What works for me, may not work for you, or the next guy. But dont rush this. Take the time and figure out how you need to deal with it. You are going to have far more good times then bad times, and don't let it get you down. Keep your chin up and keep at it. I made the transition from volunteer to paid and as I say to everyone else "I have the best job in the world". I would not give it up for anything....I think you will find the same satisfaction the longer you do it, not matter if you are volunteer or paid.
    Newly promoted Lieutenant....95C7
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    We had an initial CISDebriefing on the same day for the "major players", and another one for all of the staff the folowing day. I found it to help alot, as well as talking to and comforting my coworkers, but I have come back to Fla, and since then I have really been having the troubles. The dreams have stopped since I had a long talk with my sister, who also works there, but I still cant stop thinking about the victim, who was just SO YOUNG, and it opened wounds of my friend who just died, as we were going to go through Fire School together this Autumn....just hasnt been my year
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    I missed the background... what puts you in Florida? School, went back home from temporarily being in NJ?

    I guess it really doesn't matter, I was just looking for an understanding.

    My suggestion is since you are removed from the CISD team and co-workers who understand, consider reaching out to the local FD or EMS agency where you are in Florida. I'm sure they could put you in touch with someone locally that might be able to help you out in person.

    Its easy for me to say sitting here removed from the situation you talk about and not to be coldhearted but.... this stuff happens. If you could save every person you touch then we probably could shorten your name to just 3 letters. Unfortunately no matter the level of training, no matter the timing, no matter anything... the outcome is predetermined and you are not going to win. You have to walk away knowing you did what your training taught you and you did it to the best of your abilities. And don't let the fact that the victim passed think you didn't do it to the best of your abilities... YOU DID! Its just that the injuries sustained were not compatible with life no matter what bag of tricks you had.

    We run alot of motor vehicle accidents on a section of highway I swear is jinxed so unfortunately we see quite a few fatalities annually. None of them are easy, but each are an experience to grow from. I have been talking to a person pinned under the dash and had them code out as soon as you took the weight of the dash off and we have been on a call where you could still hear the occupant screaming as she was pinned in her on fire vehicle.

    It SUCKS flat out no way around it but you take it for the experience it was and learn something from it. Even if there is nothing technical you can learn from it you can learn that it just was not your day.

    The one thing I try and think about is how many fatalities I read about in newspapers and in these forums and I compare them with how many 'saves' and I see how dis-proportionate the number is in favor of the fatality and I realize its not just me... its the nature of the job and the bad ones will happen.

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    Born/Raised in Ocean City, moved to Satellite Beach, Fla 3 yrs ago. Went up to Jersey for "One last summer down the Shore", and saw a 3 wk EMT course, figured why not, itll help me in HM School. I was supposed to be in Navy Basic Training right now, but my jaw was fractured in an altercation in July, and I just stayed up there, after a GREAT surgery at UPENN allowed me to keep functioning.
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    Ahhh yes... milkshake diet!! Been there during high school as the result of a sports injury. It sucks... literally I guess?

    I have to confess I was a frequent statistic to the tourist count in Ocean City as a kid. My family didn't miss a summer for 12 years straight. I'm eyeing next summer potentially of re-starting the same tradition now that I have my own kids.

    Back on the subject... stick with it. I guess having 10 years(which is still nothing compared to some of these other guys) I have grown a thicker skin to let some of these things not beat me too badly. I can say that a #1 in his/her class top notch trained medic could have stood there and watched the incident happen and not made a lick of difference. It just was not meant to work out in your favor. It doesn't make it any easier to deal with initially, but you have to let that understanding sink in and you will be better equipped to deal with the next one. I had great difficulties dealing with my first fatal fire about 8 years ago. At first it was like "I'm fine, its no big deal" but when the rigs were all back in HQ and we were all cleaned up and headed home it started to set in and wouldn't go away. At the time I was of the belief that CISD was for wimps and discussed it only with select friends in the dept. I have since learned the value of these teams and continued discussion with people... even if they are objective 3rd party folks. Getting it out to someone who will listen helps, but quitting doesn't. Quitting leaves you with a negative experience without ever getting better things to replace it.

    Stick it out and despite some of our mindless banter and ******ing matches we are actually a helpful bunch if the situation warrants it!

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    I know how you feel but i figured out a pretty good way to deal with it. Here is a little story then I wll tell you how i handle it. My first car accident i went to, it was a 2 car mva between a ford escort station wagon and a moving truck. The lady in the escort ran the stop sign and got T-boned by the moving truck. The car was totalled and the lady ended up dying despite our best efforts. At first i was feeling the same way when i talked to one of my fellow firefighters. He said that people will die no matter how much you try. What you have to think about is all the lives that you will save and realize that the number of lives saved is far greater than the lives lost. I also realized that death is a natural act and will always happen. Thats just how i deal with it, im not sure if it will work for you but i figure its worth a try.

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    Quote Originally Posted by BLSboy
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    ... To be brief, my first code that I work on dies, and i cant get this out of my head. I have a hard time sleeping, and when I do, the victim seems to show up in my dreams....I cant deal with this, how can I make this stop?? I am supposed to start Fire Standards at the beginning of Oct, but now im not even sure if I want to stay in Fire-EMS???
    My first run on my first day on the cfd was a guy who got shot in the head. We left that scene and went to a woman who was dead. I forget what came after that but we killed one more on my first shift. Three in one day - and thats not my record. Bad things happen to people - thats what this job is. Were you negligent in your care of this guy? Were you goofing off instead of helping him? Did you not do what you were trained to do? If the answers are no (and I suspect they are since you seem to care about your patients) then don't sweat it. You did your best and thats all anyone expects of you. CPR - in my experience - seldom works. If someone is in that bad shape when you pull up, then you should not expect to bring them back like a miracle. You do your job, do what your training tells you and hope for the best. You won't even come close to saving them all, but when you do bring one back it feels pretty good. Stick with it and don't let one bad experience stop you from persuing the best career on earth. The fact that you care enough to expose yourself to a group of strangers seems to me to be a good sign if you can put this (and the many to come in the future) behind you. Stick with it.

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    Quote Originally Posted by BLSboy
    I was supposed to be in Navy Basic Training right now, but my jaw was fractured in an altercation in July, and I just stayed up there, after a GREAT surgery at UPENN allowed me to keep functioning.
    As a firefighter/EMT you will see some more people die. Maybe younger, maybe in more physically grotesque manners than drowning. I have never been in the military, but I imagine, with our country being at war and all of the recent natural disaster relief being provided (Tsunami, hurricane, etc.), that you stand a good chance of seeing much more death as a soldier than as a firefighter. I have a relative in the Navy who was sent to Sri Lanka (sp?) days after their disaster and had some horrible images to speak of that I won't even put in writing.
    I am not trying to scare you, just to prepare you. You can quit a job if it's not for you... You can't quit the Navy.

    You did the right thing seeking help with your oft common problem. Just don't be satisfied with typing on and reading from a computer screen. Talk to people IN PERSON! Seek any and all help offered. Seek private help if group therapy is not sufficent. Talk about the incident openly and honestly. Now is not the time to be "Manly" and act like you're OK if you really are not. Others feel or have felt as you do and will be willing to help you through this.

    Ask yourself if this is going to affect your ability to perform your duty as a lifeguard. If it does affect it, than STOP doing it until you are cofortable enough to do a good job. Children's lives depend on you doing your job, free from distraction. Children's lives depend on you! That's about as real as I can be about that.

    One more thing. If you feel the need to drink to ease the pain or to help cope with this event, DON"T DO IT! Post Traumatic Stress Disorder is one of the leading causes of alcoholism and the reason too many firefighters, soldiers, and cops are problem drinkers. Talk out this problem, don't try to drink it away.

    You will be OK, just deal with the problem. Don't hide from it. Talk it out!
    God bless,
    KC
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    If everyone who had a bad call that they couldn't shake for a while quit, our industry would lose a lot of first rate practitioners. I think that most of us have experienced something similar. My own came a couple of years ago, after more than a decade in the field. We spent an entire summer dealing with very traumatic fatalities, including two local 17 year olds we all knew, and a beloved school teacher. I spent the next month seeing the faces of every patient I'd ever lost, every time I closed my eyes. (Not a short list) For me, the solution was taking a break. I turned off my pager, turned up my discman, and jogged a lot. I talked to others on our department, who assured me that I wasn't burning out or cracking up, and encouraged me to take my time coming back. It was only about two weeks before I started missing active duty, and stopped seeing corpses in my sleep.

    Your solution may be different. You may need professional counseling. You may need to immerse yourself in your work. You may need to go to the hospital and look at the newborns. Or, there may be a great call that reminds you why what you do is so important. It may just take time, but don't give up so easily.

    A very wise paramedic once told me that there are three types of patients. Those who will live no matter what we do, those who will die no matter what we do, and those who will live or die DEPENDING on what we do. The key is to focus on those in the last category, and not dwell on the others.

    In the end, this may NOT be the career for you, but one bad call doesn't need to decide that. Good luck!

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