Last night, I had a challenging call. The specifics don’t matter all that much, but suffice it to say that a rodeo cowboy had an isolated extremity injury where he wasn’t responding to much of the analgesia options I had for him. The real issue arose when, on an isolated stretch of highway, the patient decided he wanted to get out of the ambulance, became both confused and combative, and saw me as the obstacle to getting out of the ambulance. Ended up pulling the ambulance over, getting help from my partner, EMS management, and a lot of law enforcement. (By the way, I really do love my colleagues at the Blanco County Sheriff’s Office and the Johnson City Police Department!)
A challenging call? Maybe. Maybe not. But it’s not always THAT call. It’s funny what can be a trigger for each of us in emergency services. One person’s bad call is another person’s idea of fun and excitement. And it’s not necessarily that call in isolation. It can be a run of “interesting” calls. Most likely, it’s a combination of THAT call with whatever additional personal or professional stressors you’re dealing with. And, at least in my case, it’s never a specific call. It’s a call combined with other stressors.
Fortunately, one thing I have in my favor is an excellent support network of family, EMS colleagues, and coworkers. A little bit of venting and discussing what’s on my mind, combined with some food and a lot of sleep helped to put things in a much better perspective.
I don’t have much advice to offer about any one specific call or stressor in your life, but I can tell you that the more you keep your problems to yourself, the less help and support you’ll feel you have. Stop the self-fulfilling prophecy and talk to someone. Emotions become self-doubts and cascade into things much worse without an outlet. Family provides unconditional acceptance. EMS colleagues and coworkers provide the understanding of the challenges. You have to have a support network that includes both.
And heck, if you’ve got no one else to talk to, I’ll listen.
This brings up the subject of preemptive restraints. Having reviewed a prominent case in which a patient exited the ambulance during transport, resulting in his death, and also having recently seen an episode of COPS where a patient jumped from the ambulance, this time with better results, I am moved to get my students thinking about the issues of restraining patients who have altered mental states prior to problems arising. The answers are not clear nor easy but require careful assessment and critical thinking. Just keep it in mind and when things don’t seem to be going right, consider this protection for both you and your patient.