Battle Buddies: A Military Concept for Protecting Each Other

The stress of COVID-19 has highlighted an ongoing problem in EMS to which we’ve paid too little attention: employee mental health.

COVID-19 has been unique in the mental stresses it has placed on our profession. Never in the modern history of EMS have we faced a danger so insidious, we may end up infecting our families. We know of EMS providers who have inadvertently infected their spouses, children, and parents, with tragic outcomes. This has placed an incredible burden, mentally and emotionally, on providers across the United States.

Many of us feel as if we are on point every second of the day. There is no “off” switch, no safe zone. COVID is everywhere—so where do we go to find respite? The stress is so unbearable that some providers live with suicidal thoughts, have attempted suicide, or even in some cases have died by suicide.

Few studies have examined EMS and mental health, but if we compare COVID-19 to the ramifications of September 11, 2001, we can expect members of the service will suffer a host of problems over at least the next 20 years.

In one peer-reviewed study from Arizona, the proportion of deaths attributed to suicide among EMTs was 5.2%, while the percentage among non-EMTs was 2.2%. Heartbreaking, but how will these rates compare with Portland? Rural Iowa? Houston? Miami? New York City?

In a 2018 SAMHSA publication regarding first responders’ mental health, issues such as depression, stress, post-traumatic stress, substance abuse, and suicide and suicide ideation are discussed in detail for police and fire agencies. There is no mention of EMS substance use, and the overwhelming number of studies regarding EMS are taken from overseas, where the staffing models are not comparable. SAMSHA researchers found only two studies that met the criteria to be included in this paper. One looked at firefighters and EMS personnel, making no distinction between them, so those numbers of EMS providers struggling with thoughts of suicide may be underrepresented.

The Importance of Self-Care

Self-care is an important aspect of provider mental health. Eating right, enjoying activities outside work, hobbies, and physical fitness are all important to maintaining our balance.

In the middle of a pandemic, some of these activities may be hard to participate in. Starting a new activity is not recommended either. Sandra M. Schneider, MD, FACEP, past president of ACEP, recently said during a green room discussion before a presentation for the University of New Mexico’s Project ECHO that now was not the time to take up yoga.

Starting a new activity, with its highs and lows, may increase stress and anxiety at apoint when we are already stressed out. Failing at a new activity when we are looking for success—something to distract us from the difficulties of the pandemic—would be counterproductive. If anything, we need to engage with activities we are successful at, that bring us happiness, and that, most important, take us away. Starting something new could actually increase feelings of failure.

During this pandemic it’s been challenging to evaluate our mental health and overall well-being. We may be in denial about stress or our feelings. We are generally not good assessors of our own mental and physical health and will deny or minimize the obvious. How do we monitor who’s at risk for mental health issues or suicide?

Preventive Early Intervention

One methodology used in the U.S. military that has been leveraged for healthcare providers during the pandemic is the idea of battle buddies. I first heard of this concept during the Project ECHO Clinical Rounds presentations facilitated by ASPR, the University of New Mexico, and a host of other organizations that has focused primarily on the COVID-19 pandemic. 

A variety of healthcare institutions have instituted the concept in their facilities, but amazingly, through more than 100 Project ECHO presentations and a search on social media, the battle buddy idea does not appear in any EMS organization.

Battle buddies is not mentoring; it’s more along the lines of peer-to-peer counseling and support. Think of it as a preventive early-intervention program. A battle buddy is your partner—someone who has your back, watches out for you, and you watch out for them. Above the cacophony of life, our battle buddy makes sure we are OK, and vice versa. There is a certain comfort in knowing someone has your back and you have theirs.

The U.S. military found this system reduced rates of suicide. You and you buddy keep each other informed about important information and instructions. Working collaboratively, you solve problems creatively. This makes staff more confident. Members report less stress. For new members it eases the transition. In areas where battle buddies are utilized, you see increased morale among staff, and even in the most challenging circumstances everyone carries on with a can-do spirit. There is a noticeable improvement in safety. You see improved leadership and teamwork skills. Battle buddies not only look out for each other, but they become so adept at protecting one another, they extend this to other members of the team who may flex in or out during exercises or missions.

Battle buddies not only support each other at work but are also there for everyday life. I have heard people say they feel more comfortable in situations outside of work when they are with their battle buddy. Hospitals reporting use of battle buddies have found that even though people may not have worked together for a long time, they form bonds quickly.

Benefits for a Career

The concept is not perfect, but potential disadvantages can be overcome. The biggest would probably be personality conflicts that may result in tension between individuals. While this may be huge in and of itself, it should not limit any organization’s attempt to implement a program.

Battle buddies should not be unique to the pandemic but part of a comprehensive onboarding program for every EMS service that includes a template for new members of ways to relieve stress. These stress-relieving activities should include a variety of undertakings to maintain both physical and mental health. This should be a part of every EMS system. The pandemic is unique in that it poses 24 hours a day of stress, but a comprehensive battle buddy program implemented within an EMS organization would have benefits not only during the pandemic but over the course of a career.

Resources

Albott CS, Wozniak JR, McGlinch BP, et al. Battle Buddies: Rapid Deployment of a Psychological Resilience Intervention for Health Care Workers During the Coronavirus Disease 2019 Pandemic. Anesth Analg, 2020 May 4 [epub online].

Centers for Disease Control and Prevention. Key Injury and Violence Data, www.cdc.gov/injury/wisqars/overview/key_data.html.

Moynihan E, Otis GA, Burke K, Tracy T. ‘He was an amazing son’: Off-duty FDNY EMS lieutenant takes his own life, second EMS suicide this year. New York Daily News, 2020 Jun 20; www.nydailynews.com/new-york/nyc-crime/ny-off-duty-fdny-ems-lieutenant-suicide-20200620-f5vmh3sdobemrcrtzo5uwqffty-story.html.

National Institute for Occupational Safety and Health. Emergency Medical Services Workers: Injury Data, www.cdc.gov/niosh/topics/ems/data.html.

Peterson C. Sussell A, Li J, Schumacher PK, Yeoman K, Stone DM. Suicide Rates by Industry and Occupation—National Violent Death Reporting System, 32 States, 2016. MMWR, 2020 Jan 24; 69(3): 57–62.

Ramsberger PF, Legree P, Mills L. Evaluation of the Buddy Team Assignment Program. U.S. Army Research Institute for the Behavioral and Social Sciences, 2002 Oct; https://apps.dtic.mil/dtic/tr/fulltext/u2/a408486.pdf.

Substance Abuse and Mental Health Services Administration. Disaster Technical Assistance Center Supplemental Research Bulletin, First Responders: Behavioral Health Concerns, Emergency Response, and Trauma, 2018 May; www.samhsa.govhttps://s3.amazonaws.com/HMP/hmp_ln/imported/dtac/supplementalresearchbulletin-firstresponders-may2018.pdf.

Suicide Prevention Resource Center. At-a-Glance: Safe Reporting on Suicide, www.mhawisconsin.org/Data/Sites/1/media/spcommunitybased/viimedia_info.pdf

Daniel R. Gerard, MS, RN, is EMS coordinator for Alameda, Calif. He is a recognized expert in EMS system delivery and design, EMS/health-service integration, and service delivery models for out-of-hospital care.