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Jones worked as an ambulance medical technician in his twenties. Randy Jones
This story was first published by Undark and is reproduced here as part of the Climate Desk collaboration.
Randy JonesIn the 1970s, he started his career as an emergency medical technician. He wore a smock with a clip-on tie and a smock that reduced the chance of a patient grasping him and strangling him. With few job prospects in the tiny Kansas town where he grew up, the rush of running to emergencies in an ambulance felt like God’s work. Jones remembers wearing his blood on his shirt as a badge of pride.
Then, in the early hours of New Year’s Day 1979, he plowed through a snowstorm to a call he can’t forget. Jones says he heard screaming one block away. After a night out, a young couple returned home to find their child dead. Jones was handed the baby by a fireman. He did so mouth to mouth. The parents’ wailing continued, but there would be no resuscitation, no reviving, no heroic lifesaving. He replayed that call the next night, trying to figure where he had gone wrong. Jones had nightmares about his children’s code blues later on, after seeing other infants pass away.
So much of Jones’ life was inextricably wrapped up in his career, but he no longer trusted he could do what he’d felt called to do. He says that for a time he contemplated suicide. He said that death was preferable to calling for help and having his coworkers know that he had broken. “There’s so much shame involved in it—to admit you can’t take it,” he says, adding that “co-workers lose faith in your ability to handle emergencies, and their lives depend on you.”
Today, there is also the threat of losing one’s livelihood. Many physicians Fear that state boards could suspend their license or revoke its renewal if they seek mental health care. A workplace culture that is hostile to mental health can be reinforced by the threat of formal sanctions. Seeking treatment may be seen as a career-ending decision—that a person is unfit for duty, both in the eyes of their colleagues and their profession.
Jones had changed careers by March 2020. He was working as a chaplain in a Greeley, Colorado hospital at the time. He was struck by the same emotions he felt as an EMT, when the first reports of the Covid-19 epidemic began to come in. The virus seemed poised to exacerbate an invisible epidemic—the emotional repercussions of witnessing trauma, as well as the moral distress of being unable to do what’s best for every patient. Worse, some doctors believed they could handle everything. “That’s where doctors crack,” Jones says. “You look at the world in black and white and, you know, how much of human tragedy can you take?”
Jones said that Jones and ICU staff would wear the identical masks for 12-plus hours each day in the months to come. He consoled colleagues with greasy hair. Jones watched nurses weep. Jones watched nurses cry. He said that Covid-19 was requested by a man to visit him one day. He borrowed a pair of goggles and ventured into the patient’s room—a forbidden zone. The man was about to be intubated, Jones says, and didn’t know whether he would wake up again. He wanted to make confession. Jones is not a Catholic priest, but he agreed to hear what seemed like they might be the patient’s last words. He was later reprimanded and forced to promise to never do it again. But he wished he could put his palm into patients’ hands as they passed over. And Jones could sense that he wasn’t alone in feeling like he was unable to do his job.
Then, in March 2021, Jones quit. He joined First Responder Trauma CounselorsColorado’s husband-and-wife couple Ed and Joanne Rupert founded, a non-profit organization called. The Ruperts see themselves as providing a 911 for 911 workers’ wellbeing. FRTC provides counseling and mental health services to emergency responders: dispatchers, paramedics, EMTs, paramedics, nurses, and police officers. Ruperts offer 24-hour support as well as a fully equipped Sprinter van that acts as a mobile unit.
Jones as a medevac flight chapplain (left) and fundraising for the group 911 for 911 with his dog Bing.
Randy Jones
The Colorado group seeks to address a problem that predated the pandemic. Some believe that the US’s emergency response system has in fact created an epidemic by failing care for caretakers. Exploited workforceThis is where the front line workers are confronted daily with the gap between what they can provide and what is needed. FRTC’s approach also reflects a growing interest in what is broadly known as peer support—help from people who share a similar lived experience. (All of FRTC’s clinical staff members, for instance, have professional experience working as first responders or in the military.)
Keely Phillips is the manager of peer support programs at a Canadian Mental Health Association branch. Writes in a book chapter that peers are uniquely positioned, using their experience “like a lantern on a dark path. The lantern is loaded with strategies, new perspectives, and hope for the person who is struggling.”
Both staff and administrators have found the concept to be a popular one. But sources say that, in part because it is predicated on patients’ trust, and in part because of its ambiguous definition, peer support lags in one key respect: Research on its effectiveness is limited. These programs, however, are not intended to replace reforms that address systemic problems plaguing our workforce.
Peer supporters continue to push ahead. The US Health Resources and Services Administration has spent millions over the past few years in peer support programs. Leading medical organizations and physicians have called for the implementation in health care settings. This is where a shocking number of workers are. Quit since the pandemic began. Experts agree that there is no better way to care for caregivers than one of your own.
IN THE EARLY 1970s, psychiatric clinicians borrowed hippie-era drug slang to describe the physical and mental Burnout associated with “helping” professions, such as social work and teaching. The term evolved into a generic term for exhaustion. Another related, but more narrowly defined, concept emerged in the 1990s: Providers who found themselves running low on empathy were experiencing a symptom of “compassion fatigue.” By 2013, with the release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association recognized that “experiencing repeated or extreme exposure to aversive details” of a traumatic event could qualify someone for a post-traumatic stress disorder diagnosis, provided they experienced other distressing Symptoms as well—as can be the case with first responders, where vicarious trauma is a routine part of the work.
Moral injury is a concept that has gained significant ground in recent years. Jonathan Shay was a clinical psychiatrist in the 1990s. described moral injury in the context of war: Post-traumatic stress not only stemmed from what someone had done on the battlefield, but also what they had failed to do. Wendy Dean, a psychiatrist applied this concept in health care. 2018 essaySTAT was co-authored by her. First responders can witness trauma and these events can have a stacking impact. But Dean’s critique had a more systematic bent: The US health care system forces workers to carry out orders that transgress deeply held moral beliefs. “What health care workers have said on a regular basis,” she told Undark, “is that, even before the pandemic: ‘I can’t get what I need to do my job. And I can’t get patients what they need.’”
These problems were made worse by the Covid-19 epidemic. The virus has already claimed nearly 1,000,000 lives. For some health workers, the politicized opposition to public health interventions along with other job pressures seemed to be destroying their senses of purpose. Some EstimatesNearly five percent of health care workers have quit their jobs.
Although there is no way to accurately measure mental, emotional, and moral injuries, data shows that they can have serious, widespread consequences. One 2015 Survey of more than 4,000 EMS providers found that 37 percent had contemplated suicide. Suicides are significantly higher than the general population. Officers of law enforcement, nurses, physicians. The US Senate approved the. Dr. Lorna Breen Health Care Provider Protection ActThe, named after a New York City physician who committed suicide during a Covid-19 pandemic, is the name of the new law. The legislation, which went to President Biden’s desk on March 11, would establish grants for more programing to promote mental health. However, the law would not reform professional licensing boards. They can effectively end a career. (Breen’s family Has said these fears were among the reasons she felt she could not get help.)
If there is no top-down response to the psychological crises that continue, Numerous Initiatives sprang up in recent years, particularly as Covid-19 swamped health care facilities. Many people sought the same expertise: Peers, those who had lived through it.
26 years oldJoanne Rupert is a South African native who responded to a newspaper job ad for a volunteer firefighter. Rupert worked at Head, a Boulder sports equipment company, and took flying lessons as a sideline. Incredibly, her first 911 call with the fire department was to the accident scene of a plane. Joanne instantly recognized the plane: It was her instructor’s. She was able to see his severe head injury as she drew closer. She didn’t have any medical training so she just had to watch. “At that point,” she says, “I said, ‘Wow, I never want to feel this way.’ That I can’t help, and I really wanted to help.”
Joanne went on to become an EMT and eventually took a job as a victim advocate for a local sheriff’s office, assisting those affected by crime or abuse. She was there when she heard about an accident at a quarry rock crusher. She went to check on the firefighters who responded. They showed her graphic photos of the scene, Joanne says, “as if it was another day of the week.” But not long after, she got a call at four in the morning from one of the firefighters. He was not OK, she says, and he asked her: “Can you come out?” It felt a bit like encountering the plane crash all over again. Joanne wasn’t a licensed counselor at the time, and her job with the sheriff’s office didn’t involve assisting first responders. She couldn’t help him—no matter how much she wanted to. “I can’t just self deploy and be a vigilante and take care of everyone,” she says. The incident inspired her to return to school for clinical psychology and then to start First Responder Trauma Counselors.
FRTC Offers cognitive behavioral therapy, a type of talk therapy commonly used for PTSD, as well as eye movement desensitization and reprocessing, a technique where patients recall traumatic experiences while following sensory cues, such as tracking a therapist’s finger back and forth. (The exact Mechanism by which EMDR works has been the subject of some controversy, though the American Psychological Association conditionally Recommendations it as a treatment for PTSD.) Alternative therapies that are less well-supported by evidence include hypnosis, brainspotting (an offshoot EMDR), vibroacoustic resonance therapy, which involves audible sound vibrations, and hypnosis.
But the core of their practice is predicated on having culturally competent clinicians—that is, their staff has worked as first responders. “Unless you’ve been at the dirty end of an arterial bleed, a weapon, or a hose line, you really don’t get what the feeling attached with the circumstance you’re in” is, Ed says, “and the hypervigilance that it creates over time.” Joanne says she emphasizes a pragmatic no-bullshit approach. “I’m not a touchy-feely therapist,” she says. “When people come in to see me, they don’t need me just to shake my head and go, ‘Uh-huh, mm-hmm, mm-hmm.’ That’s not going to work for a first responder. So I’m very much Knees in the dirt, blood on shirt as a therapist.”
About a year ago, the Ruperts received an unexpected call. Joanne shared a summary from the conversation with Undark. “Everything was going fine on the phone. And then the person,” Joanne pauses. “I was in the middle of a sentence, and the person hung up on me.” She’d never met the caller, and so she looked at Ed, and said, “Uh-oh.” The couple picked up a paramedic and drove to the caller’s house at 11 p.m. Joanne says, “They were just like, ‘I can’t believe you’re here. I can’t believe you’re fucking here.’” The caller, who was intoxicated, had plans to die by suicide. According to the Ruperts, they stayed with the caller until he or she felt better and then went to bed. (Data Please suggest that people who attempt suicide usually consider it for less than 24 hours before acting.)
Joanne and Ed Rupert created First Responder Trauma Counselors. This organization offers counseling and mental healthcare services for emergency responders.
Courtesy Joanne Rupert and Ed Rupert
Regional EMS administrators say that the Ruperts, and their counselors, provide something that is desperately needed. “They just stand there with you,” says Kevin Waters, an EMS battalion chief. “Not just with us individually, but just with us collectively. They stand in that space alongside you. And they say, ‘Yeah, we’re here. We’re here with you.’” Another former administrator in Fort Collins says a colleague of his had gone to group therapy, a counseling session geared towards laypeople, but he was told that they couldn’t help him after he shared details of an especially traumatic EMS call. He had been through something most people wouldn’t imagine, and probably didn’t want to share. If it weren’t for peer support, these testimonials suggest, there might be no one. Ed explains that the options available to civilians didn’t always seem like viable options to those in uniform. “The shame of calling 911 when they have a mental health crisis is overwhelming,” he says. “Everybody knows now. The toothpaste is out the tube. You can’t unring the bell.”
Ed claims that they have not taken a day off since Covid-19 arrived in Colorado on November 20, 2021. The scanner was clear that their work would never cease, and it was evident to all who listened. The wind was unusually dry for late autumn and the dispatchers reported a three car crash. Emergency responders arrived at the scene to find a plane that had crashed while fighting a wildfire. The pilot was killed.
One of thePeer support in the US was initially a movement that was led by people who were suffering from mental illness or who used drugs. They demanded alternatives to institutional care. Advocates wanted to give people control over their own care. Recent efforts have focused on professionalizing peers. Certified specialists are recognized in almost every state. Since 2007, they are reimbursed via Medicaid, the largest payer of mental healthcare services in the US. In 2016, there were 25,317 certified peer specialists nationwide.
Peer support is becoming more popular, but better empirical research and data are needed to identify or measure specific outcomes that can be attributed to it. Sharon Reif, a Brandeis University health services researcher, was one example. Reviewed 11 previously published papers, only two of which were randomized controlled trials—the gold standard for health research. Subsequent ReviewsAll inclusive One by the Research Recovery Institute, a nonprofit affiliated with Harvard Medical School, have found some positive effects—for instance, reduced relapse and improved recovery. However, interventions can vary depending on the person and how they are requesting it. “Giving support is nebulous,” Reif says, “by definition.”
Reif warns against comparing peer practitioners with traditionally trained clinicians. This could lead to a false dichotomy, she says. Many people are not receiving any support. Future studies could focus on a specific intervention such as cognitive behavioral therapy and evaluate one group that is receiving CBT, she suggests. Without a peer Comparable to a group visiting a therapist In addition to a peer. (As Reif put it, “Do peers, plus whatever else you’re doing, make a difference?”)
One, for example. Randomized controlled trial recruited 330 military veterans who were already receiving treatment for depression, such as medication or psychotherapy. The control group continued to receive their usual care: Psychotherapy or medication from a trained therapist. The experimental group received their usual care, including computer-based cognitive behavioral therapy. However, they also met with a veteran who had experienced depression. Peer-supported therapy helped improve “depression symptoms, quality of life, and mental health recovery,” the authors wrote.
While peer support may be better than none, there is no evidence that peer support can be used in place of addressing the root problem. The number of people who require mental health care is greater than those who receive it.
Similar to the pandemic, interest was also piqued in the application of the model in professional settings, especially support for and by health care workers. It is possible for practitioners to face cultural and structural obstacles in order to receive the support they need. The American Medical Association is the largest professional organization of American medical doctors. peer support training for health care workers providing formal and informal guidance to colleagues. A June 2020 newsletterThe Joint Commission, a national accreditation body for health care organizations, encouraged peer support during crises and pointed out a Johns Hopkins Hospital program called the Resilience In Stressful Events (or RISE) program.
Although research on the efficacy of peer support is limited, Cheryl Connors, a nurse and the director of RISE, says the best evidence is utilization—how often people call the support hotlines for help. In September, she told Undark that RISE had received 40 calls per day during the pandemic. Instead of 12 calls per month. Connors, a doctorate-holder in nursing, admits that she would like more evidence. She wants to know how many callers continue to seek out additional resources after speaking with a peer. “We want to study this. We want to know direct impact,” she says, “but we also feel like it’s wrong.” Asking distressed workers for feedback on confidential support sessions, she explains, could feel intrusive.
Moreover, as Jo Shapiro, an associate professor at Harvard Medical School and the founder of the Center for Professionalism and Peer Support at Brigham and Women’s Hospital in Boston, points out, there are many factors shaping the outcomes researchers would like to study, which can make it difficult to attribute any effect (or lack of effect) to peer support. “We’d like to see, ‘Did we prevent suicide?” she says. “Did we decrease burnout? Did we increase morale and productivity? These are really important outcome measures.” But those factors are difficult to study in a limited size program. Suicide, for example, “occurs way more than it should,” Shapiro says, but not frequently enough to know whether a peer support program actually helped prevent suicides.
Shapiro believes peer support has some validity. It appears to work well, with little evidence of risk. “This seems like a really reasonable thing to do. The risk of harm is very small, right? The chance of harm of not doing it is huge.” She cites the high rates of suicidal ideation. She also pointed out that the demand is there: In 2012, she and colleagues surveyed over 100 medical professionals and found that 80% of them were not satisfied with their treatment. 88 percent wanted some form of peer support.
According to Leslie Hammer, a professor of psychology at Portland State University, occupational psychologists’ recommendations for reducing on-the-job stress and trauma usually fall into several broad categories, including reducing demand and giving workers more autonomy. However, these options are not always viable in crisis situations. Peer support seems to be a third option, offering enhanced social support. Shapiro claims that she has worked with over 100 health care institutions in the establishment of programs. This concept continues to win over federal agencies and administrators. Peer support programs have seen an increase in funding from the US Health Resources and Services Administration in recent years. On March 1, President Biden Announcement a plan to “build a national certification program for peer specialists,” as part of a broader initiative to address the country’s ongoing mental health crisis.
Shapiro believes that professional peer support can help professionals to see the emotional fallout of stressful events not as a personal failing, but an occupational hazard. This can reduce stigma, and help people seek out help. “What we don’t have is proof that this is the way to do it,” Shapiro says. “But we’ll get there.”
By the end 2021Colorado has a high number of patients who require intensive care. threatened to surpass the number of available beds. Hospitals faced staffing shortages. The quitting of nurses was commonplace in droves. Randy Jones kept in touch with many of the hospital chaplains. He claims that one of his patients left the ICU and began baking cakes from her home. She also took up hospice work. After being away for a time due to a possible Covid-19 exposure, another called him. She wasn’t sure if she still had it in her to go back to critical care. Jones sympathized, and says the nurses were right to wonder: “Is my chosen profession the right thing for me? Or is it going to kill me?”
He met with a 14-year-old ICU nurse at his office. She declined to be named as she had not been granted permission by the hospital administration to speak to media. She said that she felt that her colleagues sometimes took better care when they heard the patient’s story. Covid made this more difficult, as so many patients were on ventilators. Families were only able to see each other via video-conferencing. Many ICU patients lay facedown, in a prone position, for 18 hours or more—a tactic, the ICU nurse says, used to help improve lung Oxygenation. “How, in good faith, do I keep taking care of these people day after day,” she says, “knowing that I’m not doing the absolute best that I can do?”
One patient had stayed with the woman. After eating breakfast, the woman decided to stop taking oxygen. She died soon after, alone, holding the nurse’s hand. It wasn’t so much the death; it was that the woman’s rapid decline—without that being part of her plan. “And, so for me, it was, ‘How do I go to my next day?’” the nurse says. “‘How do I take this situation that is very different for me, grow from it, share it with my co-workers, but not let it weigh heavy on my heart and not take it home to my family?’”
Jones helped her realize a simple mantra: Control what you can and manage what you can’t. According to Jones, the nurse cares for every patient the same way, even the sickest. Estimate 80 percent of hospitalized Covid-19 patients in Colorado who had not been vaccinated as of last November. She met them at their current place, regardless of their choices in life. Still, the work left her with feelings her family might never understand, burdens she didn’t want to place on her colleagues. If it sometimes seemed like society couldn’t comprehend her experience in the ICU, at least she could count on support from one of her own. She didn’t seem to feel the need to go into detail, and with Jones, she didn’t need to. He’d been there. He got it.
The Sidney Hillman Foundation provided partial funding for the reporting of this story.
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