‘It started to manifest itself after a failed resuscitation attempt on a child several years ago. While there were low-level symptoms over the years, and there were certain calls that would affect me more than others, there was much more severe recurrence after witnessing the aftermath of a plane crash over a year ago.’
Aryeh Myers, 39, is a paramedic for Magen David Adom, Israel’s national ambulance service. Before that he worked for London Ambulance Service NHS Trust for almost 10 years, as both an emergency medical technician (EMT) and paramedic. He was diagnosed with post-traumatic stress disorder (PTSD) just over a year ago.
Myers is one of an alarming number of paramedics whose mental health has suffered directly as a result of working for the ambulance service.
Recent figures published by mental health charity Mind revealed a third of ambulance staff surveyed contemplated taking their own lives due to stress and poor mental health. The results, taken from the responses of 1 600 emergency services staff and volunteers, including 308 in the ambulance service, also showed that 67% of ambulance staff contemplated leaving their job or voluntary role because of stress or poor mental health. A huge 93% reported experiencing stress, low mood and poor mental health at some point while working for the emergency services.
The figures also highlighted how 57% of ambulance staff took time off due to stress, low mood or poor mental health. These results reaffirm those published by The Observer that revealed over 40 000 days were lost by ambulance staff in 2014 due to mental health problems.
For Myers, he recalls how he took a month off work to begin treatment, including several sessions with a counsellor who taught him how to recognise triggers, how to partially ward them off, and particularly how to deal with the thoughts and reactions that those triggers bring.
‘It helped to a certain degree,’ he says. ‘At least I was able to go back to work. But there is, from what I’ve experienced, no way to completely get rid of PTSD, and certainly not if you continue working in the field where it was caused in the first place.’
Blue Light Programme
In October 2014, Mind was awarded LIBOR funding to deliver a programme to provide mental health support for emergency services staff and volunteers from police, fire, ambulance and search and rescue services across England up until 31 March 2016.
The Blue Light Programme focused on five main areas: tackling stigma and discrimination, embedding workplace wellbeing, building resilience of staff, providing information and support, and improving support pathways.
So far the programme has seen 250 000 information resources disseminated, 5 000 managers participate in line manager training, over 400 emergency services staff register to be ‘Blue Light Champions’, and 54 blue light employers and 9 national associations sign the Blue Light Time to Change pledge—a commitment to raising awareness of mental health, tackling stigma and helping enable staff and volunteers to talk more openly about their mental health at work. Currently, all ambulance services in England except East of England Ambulance Service NHS Trust have signed the pledge.
Funds have been allocated for Mind to continue to deliver the programme on a smaller scale throughout 2016/17.
Esmail Rifai, 50, is a clinical safety officer for North West Ambulance Service NHS Trust, who recently returned to work following a long period of work-related anxiety and depression. He lost a work colleague and friend to suicide.
‘My colleague taking his own life had a devastating effect on me at a time when I was coming to terms with my own mental health,’ he says.
‘At work I often take on more than time permits, which inevitably takes its toll and ultimately ends up with my own mental health deteriorating.’
Rifai is a ‘Blue Light Champion’ and has found the experience helpful in coming to terms with his own mental health issues. ‘Being involved with the Blue Light Programme has also given me some solace,’ he says. ‘Knowing that I’m helping others in itself makes me feel good—a sense of achievement.’
Exposure to shocking events
Dan Farnworth is an EMT for North West Ambulance Service NHS Trust who has also suffered from PTSD.
‘My mental health issues started about a year and a half ago,’ he says. ‘We went to a job that involved child abuse. It was awful. We did everything that we could, but unfortunately we weren’t able to save the child.’
While Farnworth understandably felt low after the job, it wasn’t until 24 hours later that he found himself unable to shake the image of the child from his head.
‘At work I wasn’t acting like myself anymore; I wasn’t socialising as much with colleagues, and generally not interacting with people.’
In addition to his work, he found the event had begun to affect his life at home as well.
‘It made me a grumpier person, and my patience was a lot shorter. It even started to affect my sleep, and I found myself having nightmares about it.
‘I’d often find myself just sat there, not really doing anything but thinking about the job, and thinking about whether there was anything else I could have done.’
The nature of work undertaken by ambulance services means there are times when paramedics find themselves turning up at the scene of a shocking or upsetting event.
‘As a paramedic there is no way to avoid seeing sights that are difficult,’ says Myers. ‘It may be one shocking call, or it may be a build up over time, but I believe we are all affected in some way by the things we see, by the emotion we experience but are forced to contain while dealing with our job. Showing any sign of emotion is still perceived as a weakness rather than an outlet, and this is one of the things that needs to change.’
Kevin Sibley is an EMT for East of England Ambulance Service NHS Trust who served 8 years within the army. A year of that time was spent in Northern Ireland where he witnessed a number of harrowing events. He remains unconvinced at the prevalence of mental health problems suffered by ambulance staff.
‘I have known people who have left the ambo service and have come back 6 months later after querying suffering mental problems,’ he says.
‘Unfortunately I think lots of people use the mental health card in the ambo. PTSD in the military is not an excuse, it’s because your mates who will die for you are killed in a horrible situation. Unfortunately I can’t compare this to the ambo service as we join to help people in road traffic collisions (RTC) etc. You [can] walk in to a hanging, RTC or decapitation.’
Sibley is of the opinion that some paramedics are quick to associate distressing events with potential mental health issues, with some reaching for the latest buzz word to explain how they are feeling.
‘I don’t mean to belittle people with issues but we were unwell,’ he says. ‘Not dealing with it, then stress, then depression. People looked for a new thing, a new name, and grabbed PTSD.’
Support for ambulance staff
Currently, ambulance services have internal debriefing support services, and through occupational health staff have access to professional counselling services. Additionally, support is provided to ambulance service staff and their families by The Ambulance Services Charity (TASC).
‘Most people will normally feel some levels of stress throughout their day—the fight or flight model enables us to cope with difficult situations,’ says Jean Hayes, director of support services for TASC. ‘However, prolonged levels of stress can sometimes have a negative impact on health and wellbeing. For some ambulance personnel, constant and increasing exposure to difficult situations may result in poor health.’
Hayes explains how since its launch in March 2015, TASC have been approached by a number of ambulance personnel suffering from low mood, stress-related illness and undiagnosed PTSD, many of whom remain in work providing a dedicated service to the general public.
As a result, the charity is currently developing a programme of support for individuals, working with a leading psychologist, which will enable ambulance personnel to recognise their own symptoms and develop strategies to help manage poor mental health.
‘Subject to funding, TASC aim to roll out this programme of work nationwide,’ says Hayes. ‘Along with other support services, TASC are here to support those working in the UK ambulance services, whenever they are facing unexpected difficulties, crisis or are in need.’
The College of Paramedics has been working closely with Mind over recent months, and is an active participant in the blue light mental health agenda nationally, along with the Association of Ambulance Chief Executives (AACE).
According to David Davis, paramedic and fellow of the College of Paramedics, the College has recognised the importance of the mental health and wellbeing of paramedics and other ambulance and pre-hospital professionals for a number of years. These include significant concerns around what many feel is an unachievable retirement age of 68, significant changes in working practices and increased workloads resulting in increased isolation of practitioners, as well as concerns over violence and aggression towards emergency services workers.
‘The research undertaken by Mind, as part of the Blue Light Programme, has reinforced anecdote with real meaningful data about the level of problems, and importantly revealed that many frontline staff were not keen on being open about mental ill health and stress for fear of either embarrassment or adverse consequences from employers or otherwise,’ says Davis.
‘The most recent data was very worrying indeed,’ he adds. ‘Particularly that 35% of those ambulance staff completing the online survey had contemplated taking their own lives.
‘There is increasing awareness of the risk of suicide among paramedics and other emergency ambulance service personnel that simply cannot be ignored, and the recent data from the Mind survey tells us that actions must be taken now to support and protect this important group of public servants.’
Davis, who is spokesperson on mental health for the College of Paramedics, goes on to highlight that the recent College of Paramedics conference revealed a clearly expressed mandate to make mental health of the membership a priority and to support the Mind programme.
‘A single suicide of one of the brave men or women who I am proud to call my colleagues is a tragedy too many,’ says Davis. ‘We must work together to tackle the issues of mental ill health, whether they be stress, depression, anxiety or post-traumatic stress disorder.’
The AACE is one of the national associations signed up to the Mind Blue Light Time to Change pledge and were fully engaged in the Blue Light Programme throughout its initial duration. According to Anna Parry, national programme manager for the AACE, the association is continuing to benefit from the work undertaken by Mind, with the Time to Change Programme Manager contributing to ongoing work the AACE is overseeing to promote and enhance the mental health and wellbeing of staff. At the national level, the AACE is collating information and data in this area to better understand what more can be done to support ambulance service staff.
‘The sector feels that there is more that could and should be done to fight mental health stigma and discrimination and to enhance the supports that are available to staff in this area,’ says Parry.
‘The mental health and wellbeing of staff subsequently features in the AACEs 2016–17 strategic priorities; these are identified and progressed by ambulance services nationally,’ she adds.
Removing the stigma
Farnworth believes that with ever increasing demand on the ambulance service, there is not as much opportunity for discussion and reflection between jobs anymore.
‘When staff attend a particularly traumatic job, they are offered some “time out” but many staff don’t take this up when they know there are patients out there waiting for our help,’ he says.
‘As much as we look out for each other, there is still a bravado or “stigma” attached with this job; we all like to think we are infallible. We are there to support the public in [their] time of need, but we tend to not ask for help ourselves.’
‘Talking to my peers has also been a massive help,’ says Farnworth. ‘It helps me realise that what I’m going through is normal, and that many people experience things like this from time to time.’
This sentiment is something that Myers finds he can also relate to:
‘The first piece of advice I would give would be “do not be ashamed”. It took me a long time to admit both to myself and to those around me that there was something wrong. There is still a stigma attached to mental health issues, particularly PTSD, in a field where it is expected that you just get on with the job, that prevents people from seeking help. A first-line defence must be to talk, be it to a colleague, a friend or a relative, or, if the need arises, to a medical professional who will be able to give guidance with reference to the right course of treatment if required.
‘Don’t be afraid to seek help. Because the subject up until very recently was taboo, it was not well known how and where to seek help, but I believe that it’s slowly improving.’
Rifai also believes that stigma surrounding mental health should be removed: ‘There is no shame or stigma attached to experiencing mental health problems, it’s just the same as breaking a bone, except no one can see that you are suffering. We are not super humans and we are just as prone to illness as anyone else, if not more.’
Blue Light Walk
To help raise awareness of mental health problems within the blue light community and get emergency service personnel talking, Farnworth has teamed up with Richard Morton, paramedic; Philip Baggaley, senior paramedic; and Gill Despard, paramedic lecturer practitioner, to walk from Scarborough RNLI to Blackpool RNLI stopping at fire, police and ambulance stations along the way. They will be raising money for the Blue Light Programme.
The walk will take place from 26–30 September and they are inviting all emergency services, as well as the general public, to join them on the ‘last leg’ from Broughton ambulance station to Blackpool RNLI. Additionally, they are putting on a Blue Light Walk Charity Ball to celebrate the success of the walk on 1 October. If you would like to support their cause or join them then visit http://www.bluelightwalk.com.
Has your mental health been affected as a result of working for the ambulance service? If so, Journal of Paramedic Practice would like to hear from you. Email jpp@markallengroup.com
Taken from Journal of Paramedic Practice, published 6 May 2016.
It was recently announced that the North East Ambulance Service NHS Foundation Trust, North West Ambulance Service NHS Trust and Yorkshire Ambulance Service NHS Trust will be coming together to form an alliance across the North of England (Association of Ambulance Chief Executives (AACE), 2016). The services have said the launch of the Northern Ambulance Alliance will help to improve the efficiency of ambulance services in the areas covered by all three Trusts.
Ali Quaile 
The A&E crisis: the burgeoning effect on paramedics
May 23, 2014 Leave a comment
As demands rise and resource pressures grow, NHS emergency services have found themselves placed under increasing pressure. This culminated in the failure of emergency departments to meet national waiting time targets in the early months of this year. The combination of these trends with claims concerning the improved outcomes that are possible by specialist trauma centres, begs the question as to the future of community and primary care services, ambulance services and hospital A&E departments. As a result, the NHS Commissioning Board (NHS England) is reviewing the future configuration of urgent and emergency services in England.
The report, drawn up by the House of Commons Health Committee, suggests that growing demand on A&E departments will make them unsustainable if effective action is not taken quickly to relieve the pressures they face (House of Commons Health Committee (HCHH), 2013a). Concerns were also raised by the committee as to the low numbers of staff in emergency departments, and the role of NHS 111.
Urgent Care Boards
The Government’s response to the pressure in emergency and urgent care revolves around improving local system management in the short term and restructuring care for the medium term. Urgent Care Boards (UCBs) have been created to implement emergency care improvement plans in the local area. However, it was felt by the Committee that UCBs would not be able to implement reforms and influence commissioning. Confusion over a number of features of UCBs, including whether they are voluntary or compulsory, temporary or permanent, established structures or informal meeting groups, has led the committee to conclude that although UCBs have the potential to provide local system management, they currently lack clear direction or executive power (HCHH, 2013a).
NHS 111
NHS 111 is the three-digit telephone service that was introduced earlier this year in an attempt to improve access to NHS urgent care services. At a critical time in the NHS when health economies are facing financial and clinical constraints, its aim is to provide patients with a number they can call when they need help or advice that is not urgent enough to use the conventional 999 service. NHS 111 operates 24 hours a day, 365 days a year, and is free to use from a landline or a mobile.
However, the Health Committee report emphasises the consensus that NHS 111 was instated by ministers prematurely, without any real understanding of the impact that it would have on other parts of the NHS, including emergency and urgent care (HCHH, 2013a). It is felt that because NHS 111 is based around triage by a call handler who is not clinically trained, it does not embody the principle of early assessment by a clinician qualified to a level where they can appropriately quantify the balance and risk. The outcome is a potential for patients to remain dissatisfied or unsure of the instructions they have been given and so remain inclined to attend A&E when it really isn’t necessary.
Despite this, it can be argued that a number of potential benefits could be seen were the ambulance service to assume a more significant role in national 111 provision. Some of the more notable benefits include (HCHH, 2013b):
Ambulance services
Along with emergency departments, ambulance services are also being met with ever increasing demands. According to the Association of Ambulance Chief Executives (AACE), in 2011–12, the total number of emergency calls was 8.49 million; this was an increase of 415 487 (5.1%) over 2011–12 (HCHH, 2013b).
Delays in ambulance to A&E handovers or transfers within urgent care are a major everyday issue for ambulance services. Currently, patients have found themselves having to wait up to eight hours in ambulances outside A&E departments. Official figures from eight of England’s ten ambulance trusts show that 3 424 patients waited more than two hours before being handed over to hospital staff during 2012/13, compared with 2 061 patients the year before (Donnelly, 2013).
The AACE recognise that the cause of these delays varies from hospital to hospital but include:
As the paramedic profession takes on broadening responsibilities, ambulance services need to be recognised as a care provider and not simply a transport service for emergency departments. The committee believes that this can be achieved in part through increasing the number of fully qualified paramedics (HCHH, 2013a). By having paramedics who are able to treat patients on-scene, conveyance rates to emergency departments can be reduced, and, therefore, pressure alleviated. In addition, paramedics would be in a position to make the difficult judgement about when to bypass the nearest A&E in favour of specialist units that offer stroke, heart attack, major trauma and specialist children’s services.
In comparison to ambulance technicians, paramedics are trained to make better clinical judgments and administer care more appropriately. It is therefore imperative that ambulance services demonstrate a commitment to establishing a ratio of paramedics to technicians, which ensures that ambulance crews are able to regard conveyance to an emergency department as only one of a range of clinical options open to them (HCHH, 2013b). The report recommends that NHS England undertakes research to establish the precise relationship between more highly-skilled ambulance crews and reduced conveyance rates (HCHH, 2013a). By making full use of the potential of ambulance services, demand pressures in emergency departments could be more easily managed and new care models developed.
References:
Donnelly L (2013) Patients facing eight-hour waits in ambulances outside A&E departments. The Telegraph. http://www.telegraph.co.uk/health/healthnews/10150635/Patients-facing-eight-hour-waits-in-ambulances-outside-AandE-departments.html
House of Commons Health Committee (2013a) Urgent and emergency services: Second report of session 2013–14. Vol 1: Report, together with formal minutes, oral and written evidence. The Stationery Office, London
House of Commons Health Committee (2013b) Written evidence from Association of Ambulance Chief Executives. ES 19. The Stationery Office, London
Taken from Journal of Paramedic Practice, published 2 August 2013.
Filed under Comment Tagged with A&E Crisis, AACE, Association of Ambulance Chief Executives, Comment, House of Commons Health Committee, Journal of Paramedic Practice, NHS 111, Urgent Care Boards