March 2, 2023 • 49 mins
Well-being is widely misunderstood and often not considered until it is too late. This 7 Things EMS on well-being is presented by an EMS provider who has been there—and done something about it. James Boomhower founded stayfit4duty.org and is pursuing his Master’s in Clinical Psychology. His discussion with Dan in this session covers a wide range of real and practical components of well-being that are surprisingly easy and intuitive.
If you're in need of support after reviewing this presentation and quiz, please don't hesitate to connect with a close friend, family member, or colleague, 988, or if you're in crisis 911.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome to the Seven Things EMS Podcast, a continuing education offering of Limmer education.
(00:12):
Seven Things EMS Podcast is designed to give you what you need to succeed in EMS, it's
conversational, informational, and without the fluff.
All right, and welcome to another episode of the Seven Things EMS Podcast.
(00:35):
I'm your host, Dan Limmer.
We have a episode I'm really looking forward to.
We're going to talk about well-being.
Well-being can be a little bit amorphous to us.
Say, we're tough, right?
We can do this stuff.
But the truth is, well-being can be more elusive than we would like to think or let us think.
And to help us get through this today is James Boomhower.
(00:58):
James Boomhauer has been nine years as a medic with Boston MedFlight, 20 years as a medic.
And following his passion, he's taking a clinical psychology with a focus in military and emergency
response professionals at Colorado State University, which makes him an ideal person to talk about
this.
And I think that's a great contribution, but the passion.
(01:19):
I'll also say, James, part of our thing in this podcast is that we don't do a lot of
fluff, but if I don't put in the fact that I was a paramedic with your father before
you were born, I think that it would just be remiss.
I think we have to at least mention that hook before we get into these seven things.
And welcome.
Thank you very much for having me.
(01:40):
It's great to be here.
And if you didn't bring it up, I sure was going to.
So.
Yes.
I can't see, fortunately, the gray in my beard, but it has been earned over some time.
And I think it's amazing where you've taken this.
And I'm really look forward to sharing these seven things.
And I think that following our plan here, let's get right into it.
(02:01):
At some point, here's number one.
At some point, everyone in medicine struggles.
It's perfectly normal.
Now I introduced these to you and I have to tell you, one of the things that happened
recently with DeMar Hamlin and the Buffalo Bills game really gave the concept of CPR
and defibrillation a big push.
(02:24):
But there's one other thing that moved me and that those big, tough football players
were standing there on the field crying.
And that was the point to me.
I get CPR and defibrillation, but here we are.
And they weren't hiding their faces.
They weren't doing it.
They were trying to find comfort in each other.
(02:44):
And I think that this goes very much into what you say at first.
Yeah, it's perfectly normal.
I think everyone struggles.
But in medicine, I think sometimes the deck is stacked against us, right from what we
see to how we feel we can deal with it.
So number one, it's yours.
You took a big part of that right out of the mix.
You're absolutely right.
(03:05):
How fortunate in such an odd way to have such a visible and well-known episode of cardiac
arrest where we not only saw the benefits of CPR and defibrillation, but we watched individuals
look at a friend who just died and how, like you said, the roughest, the toughest, the
meanest, the baddest were consoling one another.
And we're openly sobbing.
(03:27):
And it started a wonderful discussion on vicarious trauma and people that watched the game from
10 states away said, oh my God, what do I, how do I process what I just saw?
And it was an excellent jumping off point to normalize the fact that what we in healthcare
see every day is a little bit twisted, right?
(03:47):
And when we get either very clinical and talk about what the American Psychiatric Association
views as something traumatic or if we get really pragmatic and just talk about it, the
stuff that we see is really abnormal and it's okay to be affected by that.
One would argue it's not only normal, but it's expected.
(04:07):
If you start with the expectation of at some point I'm going to struggle, at some point
something's going to bother me, it's much easier for you to be compassionate to yourself
and to find the support and resources that you need.
Instead of being on this proverbial hamster wheel of I must not be a good healthcare provider
because I got a little teary-eyed during that cardiac arrest or I got a little emotional
(04:32):
when that mother held their child for the last time or insert whatever traumatic event
you want here, knowing at your first day in your program that you're going to struggle
at some point is a tremendously helpful jumping off point to be able to receive that help.
You know, one of the things you said, how do I process what I just saw?
(04:56):
I think not only in your first point, but maybe going into the second and subsequent
points, your question, how do I process what I just saw?
How many people don't even ask that question or feel the need?
How many people just plod on and say, well, I'm supposed to take this, I'm going to do
this or I'm tough and they don't even realize the amount of trauma either individually or
(05:23):
maybe even collectively what we do has people.
I don't think they even ask that question to themselves sometimes.
That's an excellent point.
If you're not even asking the question, right, you're certainly not going to be able to provide
yourself any compassion or help find yourself the support at a peer or professional level.
(05:44):
It's an important jumping off point of how am I supposed to feel?
Is this comfortable?
Is this good?
Am I okay?
How can I put that all together?
I truly think that starts by acknowledging, like I said a moment ago, that some of the
stuff we see is really wacky and some of the stuff we see is really abnormal.
A vast majority of the population, as evident by what we saw in that football game, has
(06:07):
never seen CPR be performed.
For us in the, I'll say civil service as a whole because just about every sector gets
involved during CPR, that's a pretty vanilla experience for us.
If you asked me to list out my top 10 worst, CPR might not even make the list.
I just want that to be a reminder of giving yourself the space to acknowledge that that's
(06:32):
strange and abnormal and can elicit some emotions so that you can make that step and
walk towards and say, how do I get some support?
I may be in need of support.
What does this look like and how can I get it?
All right.
I think this does take us into number two.
Keep finding a mental health provider no differently than a physical health provider.
(06:55):
If we were to say, what do I want in my doctor?
We want a good thinker, someone that's not, I mean, tell me what you think on that.
First people have to acknowledge that there may be times they have to talk to a professional.
We've gotten to that point.
(07:15):
We do little things in EMS, we support each other.
There's been a long history of debriefings and meetings and lots of other stuff.
But the truth is, most of the time we acknowledge that real help comes from a mental health
provider.
That's really the goal that we're looking for.
You're going to be one.
(07:36):
You're in school for that.
What are traits that you want to put forward and what are things that someone should look
for to go for help and maybe make that step not so intimidating or scary?
Absolutely.
You hit a lot of great points per usual.
There is a number of peer-led initiatives.
(07:57):
We all have a colleague.
We can talk to at work.
We all have friends, family.
I understand sometimes communicating with family about the job is a little touch and
go depending on your own relationships and how comfortable you are with having that dialogue.
peer support, critical incident stress, those are peer reviewed and data-based interventions.
(08:18):
They can be tremendously helpful.
Don't sleep on those because they are very, very useful in guiding you to this process
or preventing its necessity altogether.
Step one with finding a mental health provider is looking before you need one.
The longer you wait and the more in crisis you have to be to find a mental health provider,
(08:39):
the more at the will of whatever watch in the door you are at.
If we wait until we are super sick to finally try to make an appointment with a primary care
provider, we end up having to go to an emergency resource that we have no say over who that
person is, what their background is, et cetera.
It really puts us a couple of steps behind.
(09:02):
The first thing I will say is just start looking before you need one.
The mental health space is no different than the physical health space in terms of saturation
and time.
It is pretty rare to find a counselor outside of the crisis world that will be able to have
an intake session with you tomorrow.
I say that so you can start that search earlier.
(09:22):
The rest of this is very marred and debate within the psychological profession and what
is best for the first responder.
I will tell you as a student in this field and as a practitioner, if I was to give you
a checklist of what you are looking for, you want someone who is either trauma focused
in their therapy or trauma informed, those two terms delineate.
(09:46):
Essentially the care that is provided does not necessarily explain what framework they
are going to utilize, but it lets you know that they are comfortable hearing terrible
stories.
It tells you that there are no strangers to hearing, dark bleak and gory tales and should
be able to sit with you in those spaces.
I would love to know if my mental health provider has worked with or has experienced with post
(10:09):
traumatic stress disorder.
With the huge asterisk being, you don't have to have PTSD to see a mental health provider
period or to sit with one who has experience in it.
What you want is someone who knows the steps necessary if in your own professional and
(10:30):
client based interaction, they feel that you may be suffering from PTSD or CPSD, more complex
post traumatic stress disorder, when all of the stuff from the last 15 years kind of bubbles
up in contrast to one big event is the delineation there between complex PTSD and PTSD.
(10:51):
Knowing that my provider has resources there is helpful.
EMDR or eye movement desensitization therapy is a nice to have, not a need to have, but
those are my at least two big ones.
I need a therapist that is trauma centered or trauma informed, one that has familiarity
working with clients that suffer from post traumatic stress disorder.
(11:14):
If they do EMDR that's great, but it's not a requirement.
And if they're used to working with first responders, that's great, but also not a requirement.
I'd love if my client has a ton of therapeutic alliance with other first responders, but
I don't want to shoe people away from very good, very capable mental health providers
(11:34):
who don't know the difference between a fire lieutenant and a battalion chief or any EMT
or a paramedic.
They can still provide very good care and you might be able to help guide that little
bit of cultural competence they need.
So please don't pigeonhole yourself into only looking for 20 year paramedics who then go
to grad school.
I can absolutely help you find culturally competent therapists, but don't immediately
(11:58):
ex-navigate them from your list because there's plenty in the space that are becoming culturally
competent or can still provide very good care.
Just go a little bit deeper into EMDR.
That is something that's probably new to people, but is becoming very prominent in
therapy.
Let's just, a little primer on that I think might be helpful for those who are listening.
(12:20):
Totally.
So EMDR is a very abbreviated way to say eye movement desensitization and reprocessing
therapy.
Sparing you the physiology behind the thought process, what we're trying to do with EMDR
is we're taking something that is occupying a ton of space in our brain in a negative
(12:41):
way.
We think about, say, the bad car accident.
And as soon as somebody mentions that call with the bad car accident, my heart rate comes
up, my respiratory rate comes up, I start to tremble, I can smell the smoke from the
accident, I'm very emotionally and like autonomic nervous system invested in this call.
(13:02):
My brain is struggling to differentiate whether we are talking about a call I used to go on
or we are in the call right now.
And while this is not only one of the markers of symptomology for post-traumatic stress
disorder, what EMDR does is helps put that memory back into the DVD player, right, or
(13:26):
you're streaming Q for lack of a better turn of phrase.
So when you think about that after DMDR, you remember it, you acknowledge it, but it's
a call you did 10 years ago.
It's not this tremendously overwhelming experience that you suffered and can't get yourself out
of it.
(13:46):
It really does help align the brain and say, that's not a trauma that's happening to you
right now.
You are safe, you are not in harm's way.
That is a memory and it allows your brain to put it back in its memory queue, not in
the haunt you and make you go right back to a really traumatic experience.
(14:06):
As someone who is starting early training on EMDR, the one big misnomer that I'd like
to take a second and bring up is when you are in EMDR therapy, you are not going to
be forced to relive this trauma brick by brick.
There is this misconception that in order to appropriately do this therapy, you have
(14:26):
to share the entire scenario from start to finish or your therapist can't help you.
Bits and pieces of that trauma will come up, but the entire emotional retelling is not
a component of that EMDR therapy.
There are a number of ways to administer that therapy.
There are some that are somatic tapping where we tap different areas of our body.
(14:48):
There are some that we use a clicker similar to what you'd get in a hearing test and you'd
kind of click left versus right and there are a number of different modalities that
sit there.
But that end goal being, we take something that is tremendously traumatic and very stressful
to you and we remind your brain that that was a memory from the past.
(15:10):
And take something that used to keep you up at night and really stress you out and turn
it into something that you vaguely remember but can just as easily let it go, come back
to it in another time.
Wow.
All right.
That's really cool.
It's that if you're filing it, your DVDs are going to be in the right place in the rack
now, not scatter all over the floor like or your brain, you're going to put things back
(15:34):
and that's fascinating.
I'm going to go a little bit rogue here and you talked about your heart racing and different
things.
You know, when you read an EMS textbook, which I'm kind of partial to, we have a section
on well-being of the EMT.
I think it would be appropriate to just take a second and talk about some of the physical
(15:55):
and other symptoms you might get from this stress.
If you are not in a place of well-being and I will acknowledge that there are a lot of
different levels that from the bad call that you can easily resolve to, it leaves a complex
PTSD, just tell us some signs and symptoms that you would want people to be aware of
(16:19):
to say, let's have you reach out.
You don't have to go through this.
Absolutely.
The disordered sleep is a huge part of it.
What I'll say in the crisis world is we're very kind to whatever your experience is for
the first three to five days.
You suffer some tremendous trauma, terrible call, worst call of your career.
(16:44):
You go home, you shower and you try to go to sleep and you can't.
Your adrenaline is just coursing through your veins, you're wide awake.
In the trauma and stress world, we expect that.
We know there's going to be some ebb and flow for a couple days and we'll work with you
to normalize that.
We're not encouraging it, but we're saying that's perfectly normal if two days after
(17:06):
what you self-identify as a terrible, terrible call, you can't sleep for a full eight hours.
We'll talk more about rest and sleep and how that goes here in a few minutes.
We want you to know that that's normal and we want you to know that a lot of the symptomology
that I'm going to talk about here for the first 24 to 72 hours after a bad call is normal.
(17:27):
I only take the time to clarify that because I don't want anyone to be disheartened if
they have a couple days of poor sleep or they're really stressed or they're really struggling
and they go to a mental health provider and they're ready for the PTSD diagnosis and they
don't receive one.
The PTSD diagnosis takes months of maladaptive behavior to meet the markers.
(17:48):
Right now, we are just talking about stress as a whole.
The easiest way to think about it is all things sympathetic nervous system.
Dan's books explain this really well.
We all know this really well in our clinical practice.
Our heart rate is elevated.
Our respiratory rate is elevated.
Our mind is racing.
We feel engaged, but we also feel really disoriented all at the same time.
(18:13):
I keep it in line with your sympathetic nervous system because diet's really fascinating.
Some people, when they're tremendously stressed, just unhinge their jaw and eat everything in
sight.
Some people, when they're tremendously stressed, eat nothing at all.
Actually feel nauseated by the idea of eating.
Same thing with staying hydrated.
Some people just jug all the water.
We'll talk about other fluids you can take that aren't as helpful here in a minute.
(18:36):
Other people don't drink anything at all.
Tognizans 2, your heart rate, your respiratory rate, your brain as a whole.
Can I hold onto a thought?
Am I ruminating on a thought?
Is my partner trying to talk to me and I just can't keep thinking about what that kid said
to me before we took him to the hospital?
Is the only thing you've talked about in the last 24 hours, this terrible call, and
(18:58):
not your son's basketball game or not your favorite show or anything that separates you
from your professional identity?
Those really start to be the big three.
With the very important caveat, if at any point during any of this, you feel that an
appropriate solution would be to harm or kill yourself or to harm or kill someone else,
(19:23):
now is the time to incorporate 911 or 988.
That is a completely different box of crisis mental health that isn't really what we're
speaking about today but is important to identify.
Well, it may be understandable to have those thoughts.
If you do, it's tremendously important to work that out with a mental or physical health
(19:45):
professional and not sit with those thoughts by yourself.
That was awesome.
We have foreshadowed three and four in our conversation so far.
Number three, one that someone out posting in an ambulance or on a very busy day or the
(20:05):
EMS lifestyle doesn't seem to totally reconcile with but hydration, nutrition, and sleep
matter way more than you think.
As Dan mentioned, I am a board certified flight paramedic and allow the skies to open
(20:26):
right in the halo to fall.
A younger me was sitting in a flight paramedic board certification review course.
Here's what you need to succeed in this exam.
This gentleman at the time I was in my 20s, so as I'm much closer to the age I'm going
to make fun of now, I'll do some with much more compassion.
(20:46):
This gentleman in his mid 40s said, you know, flying a helicopter is hard and if you don't
eat and you don't stay hydrated, it's going to be way harder.
My buddy and I, again, two 20-something whippersnappers feed on the desk.
The pinnacle of disrespect can be like, wow.
Slamming energy drinks.
Exactly right.
Sipping our bang out of a twirly straw.
(21:08):
We're like, what is the, maybe for him, not for me.
We often think that they're the first three things we can get rid of.
I don't need to stay hydrated, especially if I'm posting because I don't want to pee
all the time.
Nutrition is a joke.
I can have extra fries if I want to and I'll sleep when I'm dead.
(21:28):
Those are routinely the three things that we put in the forget it bucket.
When I come to you on the crisis side of the coin, we just talked about that fictional
individual who had this really bad call and they come to me on the peer support and critical
incident side of the coin.
I joke that I'm an IT specialist.
Have we turned ourselves off and turned ourselves back on again?
(21:51):
Are you hydrated?
Have you eaten something and have you slept?
Because as Dan knows, because he's very physiologically sound and as some of your students and listeners
may be put in the end of the year, this, that is the parasympathetic counter punch to the
sympathetic surge that you have going on.
(22:11):
Hostage negotiators use this.
Good businessmen use this.
When things get hostile, we surround around food.
I can't stay in a sympathetic surge if I'm trying to digest food.
I also give you the caveat that in crisis, your nutrition isn't as important as it is
other times.
(22:32):
In crisis, the quantity of the calories matter more than their quality.
Raises peanut butter cup or salad have the peanut butter cup.
This will all start to spool down the sympathetic surge that you're having.
Staying hydrated helps keep our brain hydrated, helps allow that reprocessing that we just
(22:54):
mentioned with EMDR to occur without the benefit of EMDR.
Sleep is the mother of all cognitive reprocessing.
That is when, for the tech savvy in the world, we allow our computer to defrag.
We allow our computer to start to reprocess and put all of the different chunks of memory
where it's supposed to go.
(23:16):
The caveat here is if you've acquired said sleep with a fifth of Jack Daniel's, you're
not going to get good REM sleep.
So we ask you to hydrate with non-alcoholic, non-caffeinated beverages and encourage good
sleep as a one-two punch to allow that reprocessing and de-stressing to occur.
(23:38):
They are pinnacles of your care, not three things that we can let go by the wayside and
should be the three things that you are consistently looking to reacquire after every call.
The EMS folks that get mad at me when I make fun of pizza parties, take the money you're
going to spend on a pizza party and buy your employees a decent Yeti or Stanley or whatever.
(24:02):
I'm not endorsed by anybody.
Buy them a decent reusable water bottle and give them a space, a bubbler, what have you
to refill that water bottle.
If you want to give your employees something away for them to constantly stay appropriately
hydrated is an easy first step.
We won't talk a ton about nutrition on here, but be cognizant of what you're eating.
(24:24):
If every meal you have comes out of a drive-through window, we'll have to make some adjustments
relative to your individual habits and eating style and everything else.
And man, if it's less than six hours, it's not sleep.
We pride ourselves on this.
Dan has a picture of me somewhere from a straight 37-hour something out of Kenny Bunkfire Rescue
(24:48):
that he used for this picture of exhaustion in EMS.
You have to sleep.
And if you cannot sleep, you need to rest.
And the very interesting scientific side of the coin is forever we've preached six
to eight hours of sleep is what it has to be.
What we're now starting to realize is for the cognitive space, rest can be just as valuable.
(25:13):
Dan and I will talk a little bit more about this in a second, but if you're doom-scrolling
Instagram and you're mad at everything and you're arguing of posts and this and that,
what if we just switched gears?
What if we just shut our phone off for 15, 20 minutes?
We can't sleep.
That's unrealistic.
I'm at work.
What have you?
What if we just put our feet up and closed our eyes for five minutes?
(25:33):
Did a really simple breathing exercise for 90 seconds.
This idea of allowing ourselves to rest when we can't sleep shows the same cognitive reprocessing
and cognitive benefit as sleep.
So it's an excellent stopgap when everyone that's listening to your podcast is laughing
hysterically because two very well-practiced individuals in the EMS space are talking about
(25:58):
the importance of eight hours of sleep, which I myself haven't been able to obtain in a
couple of days.
So I mitigate that with rest.
I think that we've really jumped feet first into number four.
If you can't sleep, rest.
And then to preface this, I'll say a couple of things.
(26:19):
I think there's a lot of people that are listening saying, yeah, right, I could really
pull this off.
And I think you appropriately said that you recognize there are challenges to this mandatory
overtime being held over, the craziness that we experience.
And I'll also add that you're not talking about some type of cosmic Zen meditation, although
(26:42):
I don't think we're that far off on the principles to shut things off a little bit.
Think of it as simply as taking a moment for yourself and that's going to start a good
process.
Dan and I spoke at the beginning of this of some of the stuff that'll be in the show
notes and things like that.
One of the things I'll put in there is a technique called box breathing.
(27:03):
It is a simple cadence breathing exercise.
You do everything to account for.
You inhale, hold your breath, exhale, hold your breath.
And you do that at least twice.
I do it before I insubate.
I do it before I perform thorough accostomies.
I do it when my darling significant other eye are mid argument, right?
(27:25):
And I'm trying to like spool myself down.
I do it in traffic.
It is an excellent way to remind your brain.
I need to take 10 seconds away from whatever this is, insert whatever it needs to be.
And that allows me to either focus, double down and really focus on what that task is
or peel back and say I need 30 seconds for myself.
(27:49):
Dan's absolutely right.
The idea of a two week long self care EMS retreat is really not obtainable for a vast
majority of us, myself included.
So in the absence of these really big deliberate acts of self care, can I infuse little acts
of self care throughout my day and make that an infinitely more attainable thing, whether
(28:10):
I'm flying to Maine on a helicopter, sitting in a 7-11 parking lot staging or on my 18th
fly car run with my fire department.
They can all be obtained in all those spaces.
I really, I think the other thing that people will see is that if they consciously do this,
they are exhibiting power over their emotions.
(28:32):
They're taking control, even in a very small amount.
And that's the start, I think, of how good happens when it comes right down to it.
Let's keep going into number five because we're talking a lot about how to take care
of ourselves.
Some people, maybe many people, have an employee assistance program.
And you say your EAP is not the enemy.
(28:54):
And I think what some people have problems with is that it's provided by the employer.
Are they spies?
Are they, do they have an agenda?
And that's usually not the case for a mental health professional trying to do something
for you.
My stance on this has waned over the years.
And Dan can smile and remember when I used to speak so ill of an employee assistance
(29:16):
program.
So I'm going to talk very realistically about them.
First and foremost, for many of us, they're the only resource.
So let's not poo-poo the only resource we have.
Secondly, it's on our leadership within our agencies to use them correctly and not just
lob a 1-800 number at us when we're becoming a tyrannical employee and really causing some
(29:40):
problems.
And what's very, very important for all of you to remember is that somebody who's worked
with a number of counselors over the past handful of years, your counselor doesn't always
know that they're your EAP counselor.
The way that the patient comes to the counselor isn't always crystal clear.
So this person that you have hatred for because they're an EAP counselor may just be Barb from
(30:05):
the counseling group down the street who just knows that you're her 2 o'clock.
She doesn't know that you're coming from the fire department.
She doesn't know that you're an EAP referral.
She doesn't know any of it.
I remind you of that to give you some compassion to the woman or man that you're sitting across
from.
But to remind you that there are good resources there.
(30:26):
Your employer can go far in asking your EAP questions.
You can ask the same questions of your EAP counselors that I brought up in number two.
Are they trauma-informed?
Do they work with first responders?
Do they have history of working with or specializing in PTSD?
Getting that information can be so useful.
(30:48):
It shows your employees that you cared enough to ask the question.
It shows the counselors that somebody's watching.
These guys take this really seriously.
It reinforces that at some point everyone in medicine struggles.
It allows that to be a natural part of the process.
Utilizing that tool is helpful.
The comma in your EAP is not the enemy.
(31:12):
It's finding a good counselor is a lot like dating.
Man, every one of my counseling professors hates when I use this metaphor.
But it's true if you're sitting across the chair from somebody and it just doesn't work.
They don't get you.
They don't get them.
You've given it a session, maybe two, and it just doesn't jive.
You find another counselor.
(31:32):
It's actually easier to do within an employee assistance program than just outside of that
network.
You reach back out.
You say, hey, Bob and I really didn't jive.
I don't think our schedules work.
Whatever you want to say, is there another counselor in the network that I can go to?
And you have the freedom and flexibility to move.
As far as what the EAP can tell your employer, the EAP can tell your employer whether or
(31:57):
not you showed up.
And that's literally it.
There are some very small use cases where they can express some concern.
I think if James goes back to work, he's going to be violent towards Dan.
They have an ethical obligation to bring that up.
However, they would tell you that they're bringing that up.
That would not be done in a silo.
(32:19):
So all your work through that violence towards Dan some time ago.
Dan and I are virtual now.
That's the reason why there's a camera in between us.
There's a lot to be said for utilizing the tools that you have in hand because mental
health, as I said earlier, being no different than physical health doesn't have an abundance
(32:39):
of first responder counselors ready to answer 24-7.
So I want to make sure you understand what EAP is.
I also want you to understand that you may find an amazing counselor that's affiliated
with your EAP.
If you don't, go look further in the basket because there's more than one counselor within
that system.
(33:00):
And that's something that I'm happy to expand upon if anyone is interested or feeling particularly
engaged by this comment.
Reach out to me because I will talk for hours about the pros and cons of the employee assistance
program.
But please give that clinician the space and the opportunity to be a good therapist for
you instead of just assuming that it must be nonsense because it's from an EAP.
(33:25):
I would think though that if you are at a spot after a couple of appointments where you're
not feeling it, it's possible the therapist recognizes that as well, right?
That there isn't always a match and that both have to really make this work.
And a professional therapist isn't going to take it personally, especially when people
(33:46):
are lined up, like people going to a Taylor Swift concert to get in.
You have to really, I'm showing how hip I am here.
Do you notice that?
Okay, it's not that, it is fun.
But the therapist probably knows it too.
It's not personal and they know that.
Exactly.
A good clinician, the only difference here with a clinician is the clinician has an obligation
(34:10):
to be as available to you as they can be.
And I don't mean that at like two in the morning.
I mean like in the session, it's their necessity to work well with you.
So it is a bit unlikely for a therapist to say, hey, this isn't working and I'm going
to let you go.
Well, it does happen.
Most therapists would say, hey, James down in Massachusetts specializes in first responders.
(34:36):
Let's see if we can align a session with them, right?
Let's see if we can merge you to another mental health professional, which is why I say I
want you to have the freedom to do that.
And Dan is absolutely right.
Not only do they not take it personally, it doesn't matter.
It's your mental health and it's your ability to heal.
(34:58):
So while I'm being a bit unkind to my counseling colleagues, let them work that hurt out somewhere
else.
If they're super bummed that they couldn't help you, maybe they just identified a weakness
in their care and now they're going to double down and learn more about being culturally
competent.
Maybe you've done something very good for them by not placating them and saying, oh,
yeah, no, this is great.
I feel so much better, right?
(35:19):
And saying, no, I really don't feel hurt and I really don't feel that we're meeting the
goals that I need to meet.
So I would like to find someone who's better apt to do that for me.
Can be very, very helpful for our parties involved.
Yeah.
Well, that leads us into really the last couple.
And number six is there may be more resources available to you than you know.
(35:42):
What are they?
I would love nothing more than to tell you that the team here at Stay Fit For Duty is
the only and best mental health and suicide awareness advocacy platform in the world,
right?
We're it.
We are the Amazon of all things mental health and wellness.
And it's just not true.
The longer I live in this space, the more people I network and collaborate with, there
(36:03):
are more good people doing good work than you can shake a stick at.
The problem is many of us have a budget of $0.
Many of us are very busy providing care.
And many of us don't advertise, right?
We don't have budgets to do so or the ability or the times make it happen.
(36:26):
So I encourage you to find resources and ask questions.
There are peer support teams everywhere staffed with amazing people.
There are crisis hotlines that are available 24-7365 up in New England.
We have some fire and EMS specific help lines that are available 24-7.
(36:48):
And you always have one another sometimes sharing with your partner.
Hey, that call really sucked.
And I'm like thinking about trying to talk to somebody might be the oh great because
I've seen a therapist for five years and they're accepting clients or why don't you
go to this guy James who talks about this a lot on social media and maybe you can help
you find a therapist.
(37:09):
It's really helpful to just lift that rock up just a little bit and to see what's underneath
it because there are a tremendous, tremendous amount of really good resources that many
people like I said had no idea were right in their backyard.
I think when you talk to someone and they say you can talk to my therapist and then
(37:32):
all of a sudden you feel like you're hit over the head.
You think the most together person now realize that you realize they have a therapist.
And even that makes you say, you know, it's okay to do that.
I told you as we were warming up in the green room, I found that a person that I knew that
really seemed the least person to do it had been suffering some issues and got help and
(37:56):
it surprised me.
I was not only surprised but I was really moved by the way they shared it because not
only did they share it, I think helped them probably did it on purpose that they had to
talk about it, but it helped me to say, you know, everyone has a little bit of this and
were sometimes surprised really who's in therapy and that's it's good to know that others do
(38:19):
it too.
Absolutely, if I could do anything over again, that's probably a list, but one of the things
on the mental health side I do is when I started to see a therapist sincerely, right, not like
a couple EAP sessions but like really create alliance with someone and really have a mental
(38:40):
health advocate and a mental health partner for a number of years, I told all my colleagues
at work that I had a doctor's appointment because I just wasn't ready to say I was seeing
a therapist.
What that did is that made a whole bunch of people very concerned for my physical health
because James had a weekly doctor's appointment that he would fall off the grid on, you know,
(39:02):
and it would never like talk about or anything like that.
And while I don't ever want anyone to express anything that they feel would make them uncomfortable,
when I started to say, yeah, yeah, no, I'm really sorry, I made everybody so nervous.
When I said doctor, I just meant counselor, there's a woman down in Walpole that I talk
with initially at this stage of the game weekly right now, now monthly or quarterly.
(39:26):
And I'm like, I mean, Dan can see it on the camera, right?
You're like curling into yourself and you're kind of talking to the floor as you're saying
it.
And the first thing somebody said was, where did you find them?
And the second thing somebody said was, do you know if they're taking clients?
Because it was exactly what Dan said.
It was a colleague, it was somebody that, you know, I had some professional respect for,
(39:48):
it was a great clinician that said, first of all, I'm elated that you don't have some
really complex medical disorder because we've all been racking our brains trying to figure
out what you're getting weekly doctor's appointments for.
And second of all, thank you for normalizing it.
Thank you for talking about how useful it can be and how can I find one too?
So don't do it if it doesn't feel right, but there's tremendous value in being open about
(40:11):
the fact that mental health care is a necessity.
I bet it felt good for you to finally say that too.
It did, you know, it felt, hey, I hate to say it felt like I was lying to my colleagues,
but it would be something simple, right?
Like, hey, we're all going out to lunch and I'd be like, I'll meet you guys up later
because I have a doctor's appointment.
And when I started to just say, I'll meet my counselor, it's a telehealth session though
(40:35):
so I can meet you in an hour.
The answer went, okay, right, it was nothing changed.
It was great and I wasn't burdening my friends with like being concerned for my fictional
physical ailments.
Yeah, yeah, that really is a great thing.
I'm going to throw, I told you, I occasionally throw things out of the blue.
(40:56):
I think to some extent, and we're going to get into number seven, but I want to ask you
one thing first.
I believe that there's a lot of people who believe that poor mental health, that psychological
damage and EMS is inevitable.
And you see that on social media, you know, we certainly have a little bit of drama that
(41:19):
goes with it on social media and people say, you know, even in starting EMT class, you
know, I can't wait to go out be an EMT and be damaged, right?
And it doesn't, I don't know.
I think I've had my tough times and have talked to someone about it.
But all in all, I feel, feel good in my experience.
And while everyone is different, what would you say to the new person coming in?
(41:44):
Is this inevitable or can we deal with it?
Yes.
I think the answer is both.
I think it is to steal a phrase from a psychologist that I study pretty closely, to think that
you can walk through rain without getting wet is pretty ridiculous.
So to think that you can walk through all of the trauma that we will see, the pain,
(42:09):
the suffering, the angst and not be affected by that is just as ridiculous.
I think what changes is if I acknowledge that I'm affected by it and then work to care for
myself after the residue goes away, right?
It's no different than spraying your ankle.
Yeah, I talked weird, I by stepped weird, I twisted my ankle, I cared for my ankle and
(42:34):
now my ankle is good as new.
So I think the reason I said yes is because yes, I think some inevitable psychological
injury is inevitable.
The long-term damage of that injury, I think is very focused on how well we provide psychological
first aid to ourselves and one another and recognize the utility of good mental health
(42:59):
care and good self-care in mitigating that long-term stress and dysfunction.
You should do this for a living.
That was a good answer.
I totally threw that one out of the blue etch and you did well.
I think that the rain analogy was really good.
I think that things affect people differently.
I've seen a lot of things.
(43:20):
The hottest thing for me has always been seeing the pain of people left behind by something.
By seeing people experiencing grief has always been my tough spot.
And I think everybody's going to find other people can say, well, that's not that I hate
seeing kids or whatever it is, there's going to be something.
But okay, let's say that you can, through that walking through rain, you can have an
(43:44):
emotional umbrella by taking care of yourself and doing it right.
How's that?
I put something right on top of that for you.
I love it.
That was beautiful.
I want to stick with number six for one second just to bring up a really important point.
He's a weird beast.
And what triggers us changes all the time.
(44:05):
Life status, rest, hydration.
Do I have a kid?
Do I not have a kid?
All this stuff.
So as we talk about all the reasons, it's okay to not be okay.
If you're listening to this podcast and you're saying, well, none of this really clicked
with me because I'm just okay.
That is also okay.
We're not telling you you have to be triggered by any of this.
We are allowing acceptance if you are.
(44:26):
Everything is home.
You exercise well.
You rest.
You do all this stuff and you truly aren't affected by any of this.
Gold star.
Go check in on somebody that's not okay.
The only caveat to that being, make sure that you're actually okay and make sure that you
don't just have such a wall up that you're overemphasizing this foe okay rather than being
(44:48):
okay.
All right.
Wonderful addition to that.
Number seven, you can't, at least can't always find self care at target.
Now, I'm not sure if you're looking just for the department store or the discount or just
being out there in general.
I know we talked about some of the toxicity of social media that's out there.
(45:11):
Let's finish strong with number seven.
You can't always find self care at target.
Much to the chagrin of many in the ladies of both our lives.
Everyone was really upset when I put that on here.
Self care is an act that allows you to reenergize, recuperate and rest.
(45:32):
I add a layer to that and says it also helps separate your professional identity from your
personal identity because you are more than a paramedic, a police officer, a firefighter,
a military provider.
You are also a whole incapable person outside of that.
So what's the thing that you like to do?
If that thing is meeting up with friends, going to the department store, having a good
(45:55):
time, that's fantastic.
If you are running to target because that's where you're going to buy the thing that's
magically going to fix you, you're doing it wrong.
And that is where we take the time to say ensure that self care is the action and not
the place.
Far too many people overemphasize.
(46:16):
I can't take care of myself until I go to Best Pro or Target or this or that or the
other thing.
And while there's financial implications to all of that as well, it's important to say,
hang on a second, why are we going there?
What's the purpose of going there?
And I would argue that's identical to social media.
Do I just want to look at roles for five minutes to find a cute recipe or laugh at a cat video?
(46:39):
Yes.
If I find myself seven comments in with some politically misaffiliated writer or differently
affiliated than myself or some big social media, FOMED posts that I totally disagree
with and I'm on my 17th line of text in this furious ramble, I'm doing it wrong.
So make sure that it's the action and not the place or the item that you're emphasizing
(47:04):
your self care on.
I think things that are easy and available and give us instant gratification can be very
misleading as far as what we really need.
And I think that that was a wonderful finish to this and finishing.
And now I really feel we could go on and talk about this and maybe we should do a version
(47:28):
too of this.
But I think that we should mention James' website and some of the things he does.
We talk about going to the right place.
We talk about looking for good sources.
And I think he's more than proved in this episode.
His understanding and his passion for this is something I would certainly recommend.
(47:49):
The website is StayFitForDuty.org and that's typed out StayFit, the number four, the word
duty.org.
You can reach James in his organization through that website.
And it's something like I said, if you get the feel from this podcast that there's somebody
who cares and makes a difference, it gives me hope not only for this good voice that's
(48:15):
out there, but for the future of the way we are going to take care of ourselves in EMS.
The fact that you're a part of that does give me great hope.
That's an honor, sir.
I really appreciate that.
Thank you.
Well, it has the additional benefit of being true.
The episode will finish up with a 10 question multiple choice.
(48:41):
Once completing that quick quiz, you will be entitled to an hour of con-ed.
That certificate will be available to you to download right after you finish.
James, thank you for being here.
It's been a very pleasurable time for me to have this conversation and to talk to you
again and hear what you've been up to.
Dan, it's always a pleasure.
(49:02):
Thank you very much for having me.
Everyone, stay safe and be well.
Thank you for listening to another Limmer Education Continuing Education podcast.
For more podcasts that are relevant to your practice of EMS, limereducation.com, slash
seven things.
Welcome to the Seven Things EMS Podcast, a continuing education offering of Limmer education.
(00:12):
Seven Things EMS Podcast is designed to give you what you need to succeed in EMS, it's
conversational, informational, and without the fluff.
All right, and welcome to another episode of the Seven Things EMS Podcast.
(00:35):
I'm your host, Dan Limmer.
We have a episode I'm really looking forward to.
We're going to talk about well-being.
Well-being can be a little bit amorphous to us.
Say, we're tough, right?
We can do this stuff.
But the truth is, well-being can be more elusive than we would like to think or let us think.
And to help us get through this today is James Boomhower.
(00:58):
James Boomhauer has been nine years as a medic with Boston MedFlight, 20 years as a medic.
And following his passion, he's taking a clinical psychology with a focus in military and emergency
response professionals at Colorado State University, which makes him an ideal person to talk about
this.
And I think that's a great contribution, but the passion.
(01:19):
I'll also say, James, part of our thing in this podcast is that we don't do a lot of
fluff, but if I don't put in the fact that I was a paramedic with your father before
you were born, I think that it would just be remiss.
I think we have to at least mention that hook before we get into these seven things.
And welcome.
Thank you very much for having me.
(01:40):
It's great to be here.
And if you didn't bring it up, I sure was going to.
So.
Yes.
I can't see, fortunately, the gray in my beard, but it has been earned over some time.
And I think it's amazing where you've taken this.
And I'm really look forward to sharing these seven things.
And I think that following our plan here, let's get right into it.
(02:01):
At some point, here's number one.
At some point, everyone in medicine struggles.
It's perfectly normal.
Now I introduced these to you and I have to tell you, one of the things that happened
recently with DeMar Hamlin and the Buffalo Bills game really gave the concept of CPR
and defibrillation a big push.
(02:24):
But there's one other thing that moved me and that those big, tough football players
were standing there on the field crying.
And that was the point to me.
I get CPR and defibrillation, but here we are.
And they weren't hiding their faces.
They weren't doing it.
They were trying to find comfort in each other.
(02:44):
And I think that this goes very much into what you say at first.
Yeah, it's perfectly normal.
I think everyone struggles.
But in medicine, I think sometimes the deck is stacked against us, right from what we
see to how we feel we can deal with it.
So number one, it's yours.
You took a big part of that right out of the mix.
You're absolutely right.
(03:05):
How fortunate in such an odd way to have such a visible and well-known episode of cardiac
arrest where we not only saw the benefits of CPR and defibrillation, but we watched individuals
look at a friend who just died and how, like you said, the roughest, the toughest, the
meanest, the baddest were consoling one another.
And we're openly sobbing.
(03:27):
And it started a wonderful discussion on vicarious trauma and people that watched the game from
10 states away said, oh my God, what do I, how do I process what I just saw?
And it was an excellent jumping off point to normalize the fact that what we in healthcare
see every day is a little bit twisted, right?
(03:47):
And when we get either very clinical and talk about what the American Psychiatric Association
views as something traumatic or if we get really pragmatic and just talk about it, the
stuff that we see is really abnormal and it's okay to be affected by that.
One would argue it's not only normal, but it's expected.
(04:07):
If you start with the expectation of at some point I'm going to struggle, at some point
something's going to bother me, it's much easier for you to be compassionate to yourself
and to find the support and resources that you need.
Instead of being on this proverbial hamster wheel of I must not be a good healthcare provider
because I got a little teary-eyed during that cardiac arrest or I got a little emotional
(04:32):
when that mother held their child for the last time or insert whatever traumatic event
you want here, knowing at your first day in your program that you're going to struggle
at some point is a tremendously helpful jumping off point to be able to receive that help.
You know, one of the things you said, how do I process what I just saw?
(04:56):
I think not only in your first point, but maybe going into the second and subsequent
points, your question, how do I process what I just saw?
How many people don't even ask that question or feel the need?
How many people just plod on and say, well, I'm supposed to take this, I'm going to do
this or I'm tough and they don't even realize the amount of trauma either individually or
(05:23):
maybe even collectively what we do has people.
I don't think they even ask that question to themselves sometimes.
That's an excellent point.
If you're not even asking the question, right, you're certainly not going to be able to provide
yourself any compassion or help find yourself the support at a peer or professional level.
(05:44):
It's an important jumping off point of how am I supposed to feel?
Is this comfortable?
Is this good?
Am I okay?
How can I put that all together?
I truly think that starts by acknowledging, like I said a moment ago, that some of the
stuff we see is really wacky and some of the stuff we see is really abnormal.
A vast majority of the population, as evident by what we saw in that football game, has
(06:07):
never seen CPR be performed.
For us in the, I'll say civil service as a whole because just about every sector gets
involved during CPR, that's a pretty vanilla experience for us.
If you asked me to list out my top 10 worst, CPR might not even make the list.
I just want that to be a reminder of giving yourself the space to acknowledge that that's
(06:32):
strange and abnormal and can elicit some emotions so that you can make that step and
walk towards and say, how do I get some support?
I may be in need of support.
What does this look like and how can I get it?
All right.
I think this does take us into number two.
Keep finding a mental health provider no differently than a physical health provider.
(06:55):
If we were to say, what do I want in my doctor?
We want a good thinker, someone that's not, I mean, tell me what you think on that.
First people have to acknowledge that there may be times they have to talk to a professional.
We've gotten to that point.
(07:15):
We do little things in EMS, we support each other.
There's been a long history of debriefings and meetings and lots of other stuff.
But the truth is, most of the time we acknowledge that real help comes from a mental health
provider.
That's really the goal that we're looking for.
You're going to be one.
(07:36):
You're in school for that.
What are traits that you want to put forward and what are things that someone should look
for to go for help and maybe make that step not so intimidating or scary?
Absolutely.
You hit a lot of great points per usual.
There is a number of peer-led initiatives.
(07:57):
We all have a colleague.
We can talk to at work.
We all have friends, family.
I understand sometimes communicating with family about the job is a little touch and
go depending on your own relationships and how comfortable you are with having that dialogue.
peer support, critical incident stress, those are peer reviewed and data-based interventions.
(08:18):
They can be tremendously helpful.
Don't sleep on those because they are very, very useful in guiding you to this process
or preventing its necessity altogether.
Step one with finding a mental health provider is looking before you need one.
The longer you wait and the more in crisis you have to be to find a mental health provider,
(08:39):
the more at the will of whatever watch in the door you are at.
If we wait until we are super sick to finally try to make an appointment with a primary care
provider, we end up having to go to an emergency resource that we have no say over who that
person is, what their background is, et cetera.
It really puts us a couple of steps behind.
(09:02):
The first thing I will say is just start looking before you need one.
The mental health space is no different than the physical health space in terms of saturation
and time.
It is pretty rare to find a counselor outside of the crisis world that will be able to have
an intake session with you tomorrow.
I say that so you can start that search earlier.
(09:22):
The rest of this is very marred and debate within the psychological profession and what
is best for the first responder.
I will tell you as a student in this field and as a practitioner, if I was to give you
a checklist of what you are looking for, you want someone who is either trauma focused
in their therapy or trauma informed, those two terms delineate.
(09:46):
Essentially the care that is provided does not necessarily explain what framework they
are going to utilize, but it lets you know that they are comfortable hearing terrible
stories.
It tells you that there are no strangers to hearing, dark bleak and gory tales and should
be able to sit with you in those spaces.
I would love to know if my mental health provider has worked with or has experienced with post
(10:09):
traumatic stress disorder.
With the huge asterisk being, you don't have to have PTSD to see a mental health provider
period or to sit with one who has experience in it.
What you want is someone who knows the steps necessary if in your own professional and
(10:30):
client based interaction, they feel that you may be suffering from PTSD or CPSD, more complex
post traumatic stress disorder, when all of the stuff from the last 15 years kind of bubbles
up in contrast to one big event is the delineation there between complex PTSD and PTSD.
(10:51):
Knowing that my provider has resources there is helpful.
EMDR or eye movement desensitization therapy is a nice to have, not a need to have, but
those are my at least two big ones.
I need a therapist that is trauma centered or trauma informed, one that has familiarity
working with clients that suffer from post traumatic stress disorder.
(11:14):
If they do EMDR that's great, but it's not a requirement.
And if they're used to working with first responders, that's great, but also not a requirement.
I'd love if my client has a ton of therapeutic alliance with other first responders, but
I don't want to shoe people away from very good, very capable mental health providers
(11:34):
who don't know the difference between a fire lieutenant and a battalion chief or any EMT
or a paramedic.
They can still provide very good care and you might be able to help guide that little
bit of cultural competence they need.
So please don't pigeonhole yourself into only looking for 20 year paramedics who then go
to grad school.
I can absolutely help you find culturally competent therapists, but don't immediately
(11:58):
ex-navigate them from your list because there's plenty in the space that are becoming culturally
competent or can still provide very good care.
Just go a little bit deeper into EMDR.
That is something that's probably new to people, but is becoming very prominent in
therapy.
Let's just, a little primer on that I think might be helpful for those who are listening.
(12:20):
Totally.
So EMDR is a very abbreviated way to say eye movement desensitization and reprocessing
therapy.
Sparing you the physiology behind the thought process, what we're trying to do with EMDR
is we're taking something that is occupying a ton of space in our brain in a negative
(12:41):
way.
We think about, say, the bad car accident.
And as soon as somebody mentions that call with the bad car accident, my heart rate comes
up, my respiratory rate comes up, I start to tremble, I can smell the smoke from the
accident, I'm very emotionally and like autonomic nervous system invested in this call.
(13:02):
My brain is struggling to differentiate whether we are talking about a call I used to go on
or we are in the call right now.
And while this is not only one of the markers of symptomology for post-traumatic stress
disorder, what EMDR does is helps put that memory back into the DVD player, right, or
(13:26):
you're streaming Q for lack of a better turn of phrase.
So when you think about that after DMDR, you remember it, you acknowledge it, but it's
a call you did 10 years ago.
It's not this tremendously overwhelming experience that you suffered and can't get yourself out
of it.
(13:46):
It really does help align the brain and say, that's not a trauma that's happening to you
right now.
You are safe, you are not in harm's way.
That is a memory and it allows your brain to put it back in its memory queue, not in
the haunt you and make you go right back to a really traumatic experience.
(14:06):
As someone who is starting early training on EMDR, the one big misnomer that I'd like
to take a second and bring up is when you are in EMDR therapy, you are not going to
be forced to relive this trauma brick by brick.
There is this misconception that in order to appropriately do this therapy, you have
(14:26):
to share the entire scenario from start to finish or your therapist can't help you.
Bits and pieces of that trauma will come up, but the entire emotional retelling is not
a component of that EMDR therapy.
There are a number of ways to administer that therapy.
There are some that are somatic tapping where we tap different areas of our body.
(14:48):
There are some that we use a clicker similar to what you'd get in a hearing test and you'd
kind of click left versus right and there are a number of different modalities that
sit there.
But that end goal being, we take something that is tremendously traumatic and very stressful
to you and we remind your brain that that was a memory from the past.
(15:10):
And take something that used to keep you up at night and really stress you out and turn
it into something that you vaguely remember but can just as easily let it go, come back
to it in another time.
Wow.
All right.
That's really cool.
It's that if you're filing it, your DVDs are going to be in the right place in the rack
now, not scatter all over the floor like or your brain, you're going to put things back
(15:34):
and that's fascinating.
I'm going to go a little bit rogue here and you talked about your heart racing and different
things.
You know, when you read an EMS textbook, which I'm kind of partial to, we have a section
on well-being of the EMT.
I think it would be appropriate to just take a second and talk about some of the physical
(15:55):
and other symptoms you might get from this stress.
If you are not in a place of well-being and I will acknowledge that there are a lot of
different levels that from the bad call that you can easily resolve to, it leaves a complex
PTSD, just tell us some signs and symptoms that you would want people to be aware of
(16:19):
to say, let's have you reach out.
You don't have to go through this.
Absolutely.
The disordered sleep is a huge part of it.
What I'll say in the crisis world is we're very kind to whatever your experience is for
the first three to five days.
You suffer some tremendous trauma, terrible call, worst call of your career.
(16:44):
You go home, you shower and you try to go to sleep and you can't.
Your adrenaline is just coursing through your veins, you're wide awake.
In the trauma and stress world, we expect that.
We know there's going to be some ebb and flow for a couple days and we'll work with you
to normalize that.
We're not encouraging it, but we're saying that's perfectly normal if two days after
(17:06):
what you self-identify as a terrible, terrible call, you can't sleep for a full eight hours.
We'll talk more about rest and sleep and how that goes here in a few minutes.
We want you to know that that's normal and we want you to know that a lot of the symptomology
that I'm going to talk about here for the first 24 to 72 hours after a bad call is normal.
(17:27):
I only take the time to clarify that because I don't want anyone to be disheartened if
they have a couple days of poor sleep or they're really stressed or they're really struggling
and they go to a mental health provider and they're ready for the PTSD diagnosis and they
don't receive one.
The PTSD diagnosis takes months of maladaptive behavior to meet the markers.
(17:48):
Right now, we are just talking about stress as a whole.
The easiest way to think about it is all things sympathetic nervous system.
Dan's books explain this really well.
We all know this really well in our clinical practice.
Our heart rate is elevated.
Our respiratory rate is elevated.
Our mind is racing.
We feel engaged, but we also feel really disoriented all at the same time.
(18:13):
I keep it in line with your sympathetic nervous system because diet's really fascinating.
Some people, when they're tremendously stressed, just unhinge their jaw and eat everything in
sight.
Some people, when they're tremendously stressed, eat nothing at all.
Actually feel nauseated by the idea of eating.
Same thing with staying hydrated.
Some people just jug all the water.
We'll talk about other fluids you can take that aren't as helpful here in a minute.
(18:36):
Other people don't drink anything at all.
Tognizans 2, your heart rate, your respiratory rate, your brain as a whole.
Can I hold onto a thought?
Am I ruminating on a thought?
Is my partner trying to talk to me and I just can't keep thinking about what that kid said
to me before we took him to the hospital?
Is the only thing you've talked about in the last 24 hours, this terrible call, and
(18:58):
not your son's basketball game or not your favorite show or anything that separates you
from your professional identity?
Those really start to be the big three.
With the very important caveat, if at any point during any of this, you feel that an
appropriate solution would be to harm or kill yourself or to harm or kill someone else,
(19:23):
now is the time to incorporate 911 or 988.
That is a completely different box of crisis mental health that isn't really what we're
speaking about today but is important to identify.
Well, it may be understandable to have those thoughts.
If you do, it's tremendously important to work that out with a mental or physical health
(19:45):
professional and not sit with those thoughts by yourself.
That was awesome.
We have foreshadowed three and four in our conversation so far.
Number three, one that someone out posting in an ambulance or on a very busy day or the
(20:05):
EMS lifestyle doesn't seem to totally reconcile with but hydration, nutrition, and sleep
matter way more than you think.
As Dan mentioned, I am a board certified flight paramedic and allow the skies to open
(20:26):
right in the halo to fall.
A younger me was sitting in a flight paramedic board certification review course.
Here's what you need to succeed in this exam.
This gentleman at the time I was in my 20s, so as I'm much closer to the age I'm going
to make fun of now, I'll do some with much more compassion.
(20:46):
This gentleman in his mid 40s said, you know, flying a helicopter is hard and if you don't
eat and you don't stay hydrated, it's going to be way harder.
My buddy and I, again, two 20-something whippersnappers feed on the desk.
The pinnacle of disrespect can be like, wow.
Slamming energy drinks.
Exactly right.
Sipping our bang out of a twirly straw.
(21:08):
We're like, what is the, maybe for him, not for me.
We often think that they're the first three things we can get rid of.
I don't need to stay hydrated, especially if I'm posting because I don't want to pee
all the time.
Nutrition is a joke.
I can have extra fries if I want to and I'll sleep when I'm dead.
(21:28):
Those are routinely the three things that we put in the forget it bucket.
When I come to you on the crisis side of the coin, we just talked about that fictional
individual who had this really bad call and they come to me on the peer support and critical
incident side of the coin.
I joke that I'm an IT specialist.
Have we turned ourselves off and turned ourselves back on again?
(21:51):
Are you hydrated?
Have you eaten something and have you slept?
Because as Dan knows, because he's very physiologically sound and as some of your students and listeners
may be put in the end of the year, this, that is the parasympathetic counter punch to the
sympathetic surge that you have going on.
(22:11):
Hostage negotiators use this.
Good businessmen use this.
When things get hostile, we surround around food.
I can't stay in a sympathetic surge if I'm trying to digest food.
I also give you the caveat that in crisis, your nutrition isn't as important as it is
other times.
(22:32):
In crisis, the quantity of the calories matter more than their quality.
Raises peanut butter cup or salad have the peanut butter cup.
This will all start to spool down the sympathetic surge that you're having.
Staying hydrated helps keep our brain hydrated, helps allow that reprocessing that we just
(22:54):
mentioned with EMDR to occur without the benefit of EMDR.
Sleep is the mother of all cognitive reprocessing.
That is when, for the tech savvy in the world, we allow our computer to defrag.
We allow our computer to start to reprocess and put all of the different chunks of memory
where it's supposed to go.
(23:16):
The caveat here is if you've acquired said sleep with a fifth of Jack Daniel's, you're
not going to get good REM sleep.
So we ask you to hydrate with non-alcoholic, non-caffeinated beverages and encourage good
sleep as a one-two punch to allow that reprocessing and de-stressing to occur.
(23:38):
They are pinnacles of your care, not three things that we can let go by the wayside and
should be the three things that you are consistently looking to reacquire after every call.
The EMS folks that get mad at me when I make fun of pizza parties, take the money you're
going to spend on a pizza party and buy your employees a decent Yeti or Stanley or whatever.
(24:02):
I'm not endorsed by anybody.
Buy them a decent reusable water bottle and give them a space, a bubbler, what have you
to refill that water bottle.
If you want to give your employees something away for them to constantly stay appropriately
hydrated is an easy first step.
We won't talk a ton about nutrition on here, but be cognizant of what you're eating.
(24:24):
If every meal you have comes out of a drive-through window, we'll have to make some adjustments
relative to your individual habits and eating style and everything else.
And man, if it's less than six hours, it's not sleep.
We pride ourselves on this.
Dan has a picture of me somewhere from a straight 37-hour something out of Kenny Bunkfire Rescue
(24:48):
that he used for this picture of exhaustion in EMS.
You have to sleep.
And if you cannot sleep, you need to rest.
And the very interesting scientific side of the coin is forever we've preached six
to eight hours of sleep is what it has to be.
What we're now starting to realize is for the cognitive space, rest can be just as valuable.
(25:13):
Dan and I will talk a little bit more about this in a second, but if you're doom-scrolling
Instagram and you're mad at everything and you're arguing of posts and this and that,
what if we just switched gears?
What if we just shut our phone off for 15, 20 minutes?
We can't sleep.
That's unrealistic.
I'm at work.
What have you?
What if we just put our feet up and closed our eyes for five minutes?
(25:33):
Did a really simple breathing exercise for 90 seconds.
This idea of allowing ourselves to rest when we can't sleep shows the same cognitive reprocessing
and cognitive benefit as sleep.
So it's an excellent stopgap when everyone that's listening to your podcast is laughing
hysterically because two very well-practiced individuals in the EMS space are talking about
(25:58):
the importance of eight hours of sleep, which I myself haven't been able to obtain in a
couple of days.
So I mitigate that with rest.
I think that we've really jumped feet first into number four.
If you can't sleep, rest.
And then to preface this, I'll say a couple of things.
(26:19):
I think there's a lot of people that are listening saying, yeah, right, I could really
pull this off.
And I think you appropriately said that you recognize there are challenges to this mandatory
overtime being held over, the craziness that we experience.
And I'll also add that you're not talking about some type of cosmic Zen meditation, although
(26:42):
I don't think we're that far off on the principles to shut things off a little bit.
Think of it as simply as taking a moment for yourself and that's going to start a good
process.
Dan and I spoke at the beginning of this of some of the stuff that'll be in the show
notes and things like that.
One of the things I'll put in there is a technique called box breathing.
(27:03):
It is a simple cadence breathing exercise.
You do everything to account for.
You inhale, hold your breath, exhale, hold your breath.
And you do that at least twice.
I do it before I insubate.
I do it before I perform thorough accostomies.
I do it when my darling significant other eye are mid argument, right?
(27:25):
And I'm trying to like spool myself down.
I do it in traffic.
It is an excellent way to remind your brain.
I need to take 10 seconds away from whatever this is, insert whatever it needs to be.
And that allows me to either focus, double down and really focus on what that task is
or peel back and say I need 30 seconds for myself.
(27:49):
Dan's absolutely right.
The idea of a two week long self care EMS retreat is really not obtainable for a vast
majority of us, myself included.
So in the absence of these really big deliberate acts of self care, can I infuse little acts
of self care throughout my day and make that an infinitely more attainable thing, whether
(28:10):
I'm flying to Maine on a helicopter, sitting in a 7-11 parking lot staging or on my 18th
fly car run with my fire department.
They can all be obtained in all those spaces.
I really, I think the other thing that people will see is that if they consciously do this,
they are exhibiting power over their emotions.
(28:32):
They're taking control, even in a very small amount.
And that's the start, I think, of how good happens when it comes right down to it.
Let's keep going into number five because we're talking a lot about how to take care
of ourselves.
Some people, maybe many people, have an employee assistance program.
And you say your EAP is not the enemy.
(28:54):
And I think what some people have problems with is that it's provided by the employer.
Are they spies?
Are they, do they have an agenda?
And that's usually not the case for a mental health professional trying to do something
for you.
My stance on this has waned over the years.
And Dan can smile and remember when I used to speak so ill of an employee assistance
(29:16):
program.
So I'm going to talk very realistically about them.
First and foremost, for many of us, they're the only resource.
So let's not poo-poo the only resource we have.
Secondly, it's on our leadership within our agencies to use them correctly and not just
lob a 1-800 number at us when we're becoming a tyrannical employee and really causing some
(29:40):
problems.
And what's very, very important for all of you to remember is that somebody who's worked
with a number of counselors over the past handful of years, your counselor doesn't always
know that they're your EAP counselor.
The way that the patient comes to the counselor isn't always crystal clear.
So this person that you have hatred for because they're an EAP counselor may just be Barb from
(30:05):
the counseling group down the street who just knows that you're her 2 o'clock.
She doesn't know that you're coming from the fire department.
She doesn't know that you're an EAP referral.
She doesn't know any of it.
I remind you of that to give you some compassion to the woman or man that you're sitting across
from.
But to remind you that there are good resources there.
(30:26):
Your employer can go far in asking your EAP questions.
You can ask the same questions of your EAP counselors that I brought up in number two.
Are they trauma-informed?
Do they work with first responders?
Do they have history of working with or specializing in PTSD?
Getting that information can be so useful.
(30:48):
It shows your employees that you cared enough to ask the question.
It shows the counselors that somebody's watching.
These guys take this really seriously.
It reinforces that at some point everyone in medicine struggles.
It allows that to be a natural part of the process.
Utilizing that tool is helpful.
The comma in your EAP is not the enemy.
(31:12):
It's finding a good counselor is a lot like dating.
Man, every one of my counseling professors hates when I use this metaphor.
But it's true if you're sitting across the chair from somebody and it just doesn't work.
They don't get you.
They don't get them.
You've given it a session, maybe two, and it just doesn't jive.
You find another counselor.
(31:32):
It's actually easier to do within an employee assistance program than just outside of that
network.
You reach back out.
You say, hey, Bob and I really didn't jive.
I don't think our schedules work.
Whatever you want to say, is there another counselor in the network that I can go to?
And you have the freedom and flexibility to move.
As far as what the EAP can tell your employer, the EAP can tell your employer whether or
(31:57):
not you showed up.
And that's literally it.
There are some very small use cases where they can express some concern.
I think if James goes back to work, he's going to be violent towards Dan.
They have an ethical obligation to bring that up.
However, they would tell you that they're bringing that up.
That would not be done in a silo.
(32:19):
So all your work through that violence towards Dan some time ago.
Dan and I are virtual now.
That's the reason why there's a camera in between us.
There's a lot to be said for utilizing the tools that you have in hand because mental
health, as I said earlier, being no different than physical health doesn't have an abundance
(32:39):
of first responder counselors ready to answer 24-7.
So I want to make sure you understand what EAP is.
I also want you to understand that you may find an amazing counselor that's affiliated
with your EAP.
If you don't, go look further in the basket because there's more than one counselor within
that system.
(33:00):
And that's something that I'm happy to expand upon if anyone is interested or feeling particularly
engaged by this comment.
Reach out to me because I will talk for hours about the pros and cons of the employee assistance
program.
But please give that clinician the space and the opportunity to be a good therapist for
you instead of just assuming that it must be nonsense because it's from an EAP.
(33:25):
I would think though that if you are at a spot after a couple of appointments where you're
not feeling it, it's possible the therapist recognizes that as well, right?
That there isn't always a match and that both have to really make this work.
And a professional therapist isn't going to take it personally, especially when people
(33:46):
are lined up, like people going to a Taylor Swift concert to get in.
You have to really, I'm showing how hip I am here.
Do you notice that?
Okay, it's not that, it is fun.
But the therapist probably knows it too.
It's not personal and they know that.
Exactly.
A good clinician, the only difference here with a clinician is the clinician has an obligation
(34:10):
to be as available to you as they can be.
And I don't mean that at like two in the morning.
I mean like in the session, it's their necessity to work well with you.
So it is a bit unlikely for a therapist to say, hey, this isn't working and I'm going
to let you go.
Well, it does happen.
Most therapists would say, hey, James down in Massachusetts specializes in first responders.
(34:36):
Let's see if we can align a session with them, right?
Let's see if we can merge you to another mental health professional, which is why I say I
want you to have the freedom to do that.
And Dan is absolutely right.
Not only do they not take it personally, it doesn't matter.
It's your mental health and it's your ability to heal.
(34:58):
So while I'm being a bit unkind to my counseling colleagues, let them work that hurt out somewhere
else.
If they're super bummed that they couldn't help you, maybe they just identified a weakness
in their care and now they're going to double down and learn more about being culturally
competent.
Maybe you've done something very good for them by not placating them and saying, oh,
yeah, no, this is great.
I feel so much better, right?
(35:19):
And saying, no, I really don't feel hurt and I really don't feel that we're meeting the
goals that I need to meet.
So I would like to find someone who's better apt to do that for me.
Can be very, very helpful for our parties involved.
Yeah.
Well, that leads us into really the last couple.
And number six is there may be more resources available to you than you know.
(35:42):
What are they?
I would love nothing more than to tell you that the team here at Stay Fit For Duty is
the only and best mental health and suicide awareness advocacy platform in the world,
right?
We're it.
We are the Amazon of all things mental health and wellness.
And it's just not true.
The longer I live in this space, the more people I network and collaborate with, there
(36:03):
are more good people doing good work than you can shake a stick at.
The problem is many of us have a budget of $0.
Many of us are very busy providing care.
And many of us don't advertise, right?
We don't have budgets to do so or the ability or the times make it happen.
(36:26):
So I encourage you to find resources and ask questions.
There are peer support teams everywhere staffed with amazing people.
There are crisis hotlines that are available 24-7365 up in New England.
We have some fire and EMS specific help lines that are available 24-7.
(36:48):
And you always have one another sometimes sharing with your partner.
Hey, that call really sucked.
And I'm like thinking about trying to talk to somebody might be the oh great because
I've seen a therapist for five years and they're accepting clients or why don't you
go to this guy James who talks about this a lot on social media and maybe you can help
you find a therapist.
(37:09):
It's really helpful to just lift that rock up just a little bit and to see what's underneath
it because there are a tremendous, tremendous amount of really good resources that many
people like I said had no idea were right in their backyard.
I think when you talk to someone and they say you can talk to my therapist and then
(37:32):
all of a sudden you feel like you're hit over the head.
You think the most together person now realize that you realize they have a therapist.
And even that makes you say, you know, it's okay to do that.
I told you as we were warming up in the green room, I found that a person that I knew that
really seemed the least person to do it had been suffering some issues and got help and
(37:56):
it surprised me.
I was not only surprised but I was really moved by the way they shared it because not
only did they share it, I think helped them probably did it on purpose that they had to
talk about it, but it helped me to say, you know, everyone has a little bit of this and
were sometimes surprised really who's in therapy and that's it's good to know that others do
(38:19):
it too.
Absolutely, if I could do anything over again, that's probably a list, but one of the things
on the mental health side I do is when I started to see a therapist sincerely, right, not like
a couple EAP sessions but like really create alliance with someone and really have a mental
(38:40):
health advocate and a mental health partner for a number of years, I told all my colleagues
at work that I had a doctor's appointment because I just wasn't ready to say I was seeing
a therapist.
What that did is that made a whole bunch of people very concerned for my physical health
because James had a weekly doctor's appointment that he would fall off the grid on, you know,
(39:02):
and it would never like talk about or anything like that.
And while I don't ever want anyone to express anything that they feel would make them uncomfortable,
when I started to say, yeah, yeah, no, I'm really sorry, I made everybody so nervous.
When I said doctor, I just meant counselor, there's a woman down in Walpole that I talk
with initially at this stage of the game weekly right now, now monthly or quarterly.
(39:26):
And I'm like, I mean, Dan can see it on the camera, right?
You're like curling into yourself and you're kind of talking to the floor as you're saying
it.
And the first thing somebody said was, where did you find them?
And the second thing somebody said was, do you know if they're taking clients?
Because it was exactly what Dan said.
It was a colleague, it was somebody that, you know, I had some professional respect for,
(39:48):
it was a great clinician that said, first of all, I'm elated that you don't have some
really complex medical disorder because we've all been racking our brains trying to figure
out what you're getting weekly doctor's appointments for.
And second of all, thank you for normalizing it.
Thank you for talking about how useful it can be and how can I find one too?
So don't do it if it doesn't feel right, but there's tremendous value in being open about
(40:11):
the fact that mental health care is a necessity.
I bet it felt good for you to finally say that too.
It did, you know, it felt, hey, I hate to say it felt like I was lying to my colleagues,
but it would be something simple, right?
Like, hey, we're all going out to lunch and I'd be like, I'll meet you guys up later
because I have a doctor's appointment.
And when I started to just say, I'll meet my counselor, it's a telehealth session though
(40:35):
so I can meet you in an hour.
The answer went, okay, right, it was nothing changed.
It was great and I wasn't burdening my friends with like being concerned for my fictional
physical ailments.
Yeah, yeah, that really is a great thing.
I'm going to throw, I told you, I occasionally throw things out of the blue.
(40:56):
I think to some extent, and we're going to get into number seven, but I want to ask you
one thing first.
I believe that there's a lot of people who believe that poor mental health, that psychological
damage and EMS is inevitable.
And you see that on social media, you know, we certainly have a little bit of drama that
(41:19):
goes with it on social media and people say, you know, even in starting EMT class, you
know, I can't wait to go out be an EMT and be damaged, right?
And it doesn't, I don't know.
I think I've had my tough times and have talked to someone about it.
But all in all, I feel, feel good in my experience.
And while everyone is different, what would you say to the new person coming in?
(41:44):
Is this inevitable or can we deal with it?
Yes.
I think the answer is both.
I think it is to steal a phrase from a psychologist that I study pretty closely, to think that
you can walk through rain without getting wet is pretty ridiculous.
So to think that you can walk through all of the trauma that we will see, the pain,
(42:09):
the suffering, the angst and not be affected by that is just as ridiculous.
I think what changes is if I acknowledge that I'm affected by it and then work to care for
myself after the residue goes away, right?
It's no different than spraying your ankle.
Yeah, I talked weird, I by stepped weird, I twisted my ankle, I cared for my ankle and
(42:34):
now my ankle is good as new.
So I think the reason I said yes is because yes, I think some inevitable psychological
injury is inevitable.
The long-term damage of that injury, I think is very focused on how well we provide psychological
first aid to ourselves and one another and recognize the utility of good mental health
(42:59):
care and good self-care in mitigating that long-term stress and dysfunction.
You should do this for a living.
That was a good answer.
I totally threw that one out of the blue etch and you did well.
I think that the rain analogy was really good.
I think that things affect people differently.
I've seen a lot of things.
(43:20):
The hottest thing for me has always been seeing the pain of people left behind by something.
By seeing people experiencing grief has always been my tough spot.
And I think everybody's going to find other people can say, well, that's not that I hate
seeing kids or whatever it is, there's going to be something.
But okay, let's say that you can, through that walking through rain, you can have an
(43:44):
emotional umbrella by taking care of yourself and doing it right.
How's that?
I put something right on top of that for you.
I love it.
That was beautiful.
I want to stick with number six for one second just to bring up a really important point.
He's a weird beast.
And what triggers us changes all the time.
(44:05):
Life status, rest, hydration.
Do I have a kid?
Do I not have a kid?
All this stuff.
So as we talk about all the reasons, it's okay to not be okay.
If you're listening to this podcast and you're saying, well, none of this really clicked
with me because I'm just okay.
That is also okay.
We're not telling you you have to be triggered by any of this.
We are allowing acceptance if you are.
(44:26):
Everything is home.
You exercise well.
You rest.
You do all this stuff and you truly aren't affected by any of this.
Gold star.
Go check in on somebody that's not okay.
The only caveat to that being, make sure that you're actually okay and make sure that you
don't just have such a wall up that you're overemphasizing this foe okay rather than being
(44:48):
okay.
All right.
Wonderful addition to that.
Number seven, you can't, at least can't always find self care at target.
Now, I'm not sure if you're looking just for the department store or the discount or just
being out there in general.
I know we talked about some of the toxicity of social media that's out there.
(45:11):
Let's finish strong with number seven.
You can't always find self care at target.
Much to the chagrin of many in the ladies of both our lives.
Everyone was really upset when I put that on here.
Self care is an act that allows you to reenergize, recuperate and rest.
(45:32):
I add a layer to that and says it also helps separate your professional identity from your
personal identity because you are more than a paramedic, a police officer, a firefighter,
a military provider.
You are also a whole incapable person outside of that.
So what's the thing that you like to do?
If that thing is meeting up with friends, going to the department store, having a good
(45:55):
time, that's fantastic.
If you are running to target because that's where you're going to buy the thing that's
magically going to fix you, you're doing it wrong.
And that is where we take the time to say ensure that self care is the action and not
the place.
Far too many people overemphasize.
(46:16):
I can't take care of myself until I go to Best Pro or Target or this or that or the
other thing.
And while there's financial implications to all of that as well, it's important to say,
hang on a second, why are we going there?
What's the purpose of going there?
And I would argue that's identical to social media.
Do I just want to look at roles for five minutes to find a cute recipe or laugh at a cat video?
(46:39):
Yes.
If I find myself seven comments in with some politically misaffiliated writer or differently
affiliated than myself or some big social media, FOMED posts that I totally disagree
with and I'm on my 17th line of text in this furious ramble, I'm doing it wrong.
So make sure that it's the action and not the place or the item that you're emphasizing
(47:04):
your self care on.
I think things that are easy and available and give us instant gratification can be very
misleading as far as what we really need.
And I think that that was a wonderful finish to this and finishing.
And now I really feel we could go on and talk about this and maybe we should do a version
(47:28):
too of this.
But I think that we should mention James' website and some of the things he does.
We talk about going to the right place.
We talk about looking for good sources.
And I think he's more than proved in this episode.
His understanding and his passion for this is something I would certainly recommend.
(47:49):
The website is StayFitForDuty.org and that's typed out StayFit, the number four, the word
duty.org.
You can reach James in his organization through that website.
And it's something like I said, if you get the feel from this podcast that there's somebody
who cares and makes a difference, it gives me hope not only for this good voice that's
(48:15):
out there, but for the future of the way we are going to take care of ourselves in EMS.
The fact that you're a part of that does give me great hope.
That's an honor, sir.
I really appreciate that.
Thank you.
Well, it has the additional benefit of being true.
The episode will finish up with a 10 question multiple choice.
(48:41):
Once completing that quick quiz, you will be entitled to an hour of con-ed.
That certificate will be available to you to download right after you finish.
James, thank you for being here.
It's been a very pleasurable time for me to have this conversation and to talk to you
again and hear what you've been up to.
Dan, it's always a pleasure.
(49:02):
Thank you very much for having me.
Everyone, stay safe and be well.
Thank you for listening to another Limmer Education Continuing Education podcast.
For more podcasts that are relevant to your practice of EMS, limereducation.com, slash
seven things.
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