April 2004 Letters

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Mail: EMS, 7626 Densmore Ave.
Van Nuys, CA 91406-2042
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When Warnings Are Ignored

I had a chance to read Thom Dick's October EMS Reruns column, Treasure At Risk: Watching Out for Discouraged Colleagues. It was a good article, but one part seemed to be left out. I am a young firefighter/paramedic in a small town outside Chicago. I have been in the fire service for seven years now, and have run across this problem twice already.

In both cases, I saw that a partner/brother was going through a hard time. Both individuals would sometimes say things that would alarm me. I of course went straight to my lieutenant/captain and told them of the situation. The problem was, that was where it stopped. Of course I don't know what happened behind closed doors or in the chief's office, but in both cases it seemed the situation was just left alone.

In one case, this brother's depression (for lack of a better term) went on for more than a year before the department took any action. When they did, it was minimal. Action was only taken after a number of complaints, first about the individual involved, later from colleagues concerned about their safety working with him. It seemed that this small department was scared to do anything because it was too personal. In my opinion, they didn't intercede because they didn't want to insult a friend.

The problem, of course, is that what if next time they wait too long, and it becomes too late? How do you make officers take notice when someone in the rank-and-file brings something like this to their attention? From a more selfish point of view, if your partner is not in his right state of mind, how can you count on him to do his job? This job is dangerous, and when someone's not 100%, people can get hurt.

I guess what I'm really looking for is advice on what path to take if I come across this problem again and feel the department isn't doing enough to correct it.

Tom Foley, FF/EMT-P
via e-mail

Thom Dick replies: Tom, thanks for writing and for caring. I have been to EMS funerals-they're terrible. They break your heart, and they always leave you wishing you had done more to prevent them-especially when they're about preventable things.

I believe the solution to situations that don't seem to be producing helpful results is-persist! Even though doing something is better than doing nothing, sometimes something isn't enough. When you get stung by a mosquito, you scratch yourself. But when you get stung by lots of mosquitoes, you reach for the repellent.

Sometimes the key is competing successfully with the brass' other priorities by convincing them what you're telling them is urgent. The best way to do that-when it really is urgent-may be to get in their faces.

I hope that doesn't sound too simple to be real, but I have found that it works. At least it works better than waiting for the funeral.

A Map for the Minefield

What a helpful column by Chris Hendricks (The Power of Words, Customer Care) in October's issue. Giving caregivers words when they are hard to come by in difficult situations helps bring a needed degree of empathy and professionalism to the effort. Having a script to guide you is the easiest way, and possibly the best way, to step through a verbal minefield.

I am a volunteer firefighter/paramedic. However, my chosen profession is that of funeral director. Consequently, I see both sides of this fence each day. The only caution I would bring to your readers pertains to the use of one simple phrase: Stay away from "I understand" if at all possible. Even if you have been through similar circumstances in your own life, most people will not believe that you actually understand how they feel, where they are coming from or what they are going through. Even if they have specifically told you this in detail, you may still be interpreted in a manner other than what you intended.

Thanks for your words, Chris. I'm sure you won't mind a bit if we borrow them.

Craig Marshall, LFD, EMT-P
Assistant Chief
Sidney (IA) Fire & Rescue

CISD Alternatives

Thank you for the informative story in your December 2003 issue regarding CISD. This treatment modality is rapidly falling out of favor, and the article does an excellent job addressing this. However, I do wish to point out that two of the "other treatment modalities" mentioned are no better than CISD. As the authors point out, eye movement desensitization and reprocessing (EMDR) and thought field therapy (TFT) have almost no empirical evidence for their effectiveness. To list them as other treatment modalities distracts from the most effective and only empirically supported treatment: cognitive-behavioral therapy (CBT). Our efforts to support those in EMS would be best served by making them aware that this treatment exists and helping them access providers who practice CBT.

Thomas Dunn, PhD, EMT
University of Northern Colorado
Pridemark Paramedics
Boulder, CO

Corrections

I had to write to point out a significant error in the otherwise well-written and informative article Pediatric Pulmonary Emergencies in the January 2004 issue. On page 74, Atrovent is listed as a beta-agonist, which is incorrect. It is an anticholinergic (acetylcholinesterase inhibitor) and, although a bronchodilator, is not interchangeable with the beta-agonist class of drugs. Thanks for noting this oversight.

Paul Jensen, PharmD, MD
Medical Director, Howard County EMS
Cresco, IA

The editor replies: Thank you for bringing this error to our attention. You are correct: Atrovent is an anticholinergic. It was accidentally placed with the beta-agonists in the story. Our apologies for the error and any confusion it may have caused.

In the February Vital Signs, the article entitled Coast Guard Looking for Healthcare Providers contained an incorrect URL for the relevant USCG auxiliary healthcare website. The correct site is www.uscg.mil/ccs/cit/ cim/directives/ci/ci_6010_2.pdf.

In EMS Reruns in February EMS, the website listed for the National Coalition for Domestic Abuse Awareness was incorrect. The correct address is www.ncadv.org.

EMS regrets these errors and any inconvenience they may have caused.