Tia Dickson, RN, BSN

Primary Children's Hospital

A new year, a time of resolutions, and a great time to talk about provider resilience. While this topic is not directly related to pediatric patientcare, many times it's a tough pediatric call that throws us over the edge. Emergency medical service work puts us at higher risk for suicide, job-related burnout, and clinical depression. Personal health and physical, emotional, and mental wellness play a critical role in helping us thrive in this field. Events since the pandemic have brought urgent attention to the importance of resilience in protecting EMS practitioners from the most stressful aspects of their profession. Let us resolve to build resilience in 2023!

Choosing resilience

Joy Montoya MS, CHES

Excerpts from December 12th PETOS

According to the Centers for Disease Control and Prevention (CDC) WISQARS Leading Causes of Death Reports, in 2020:

• Suicide was the twelfth leading cause of death overall in the United States, claiming the lives of more than 45,900 people.
• Suicide was the second leading cause of death among individuals between the ages of 10-14 and 25-34 , the third leading cause of death among individuals between the ages of 15-24, and the fourth leading cause of death among individuals between the ages of 35 and 44.
• There were nearly two times as many suicides (45,979) in the United States as there were homicides (24,576).

Table 1 shows the 12 leading causes of death in the United States, and the number of deaths attributed to each cause. Data are shown for all ages and select age groups where suicide was one of the leading 12 causes of death in 2020. The data are based on death certificate information compiled by the CDC.

Everyone is at risk for suicide. More than 12 million adults reported having serious thoughts of suicide in the 2020 study. It can affect us all.

It is estimated that 30% of first responders develop behavioral health conditions. Post traumatic stress is well documented in our profession but we should recognize that post traumatic growth is possible and, in fact, it should be our goal when building resilience.

There are many definitions of resilience. Flexibility, the ability to adapt to a challenge or threat, and healthy recovery from extreme stress are common definitions. It is a whole spectrum of things. Resilient people have the capacity to bounce back mentally and emotionally from setbacks. When dealing with a traumatic or stressful situation, resilient people can process what happened and cope in healthy ways. Faced with hard times, the resilient are eventually able to resume optimal functioning and may even grow from the experience.

The good news is that whatever definition you ascribe to, resilience is a learned skill. Researcher Glenn E. Richardson grouped together forces that drive resilience. Which of them are you willing to try?

Noble: tap into your own meaning in life

• Self reflection (gratitude journaling)
• What do you value?
• What do you want to be your legacy?

Childlike: spend time with children and/or follow their example

• Have an adventure
• Cultivate art/hobbies/creativity
• Laugh
• Be spontaneous
• Hope and dream

Character: live up to you own expectations

• What expectations do you have for yourself?
• What are the qualities you most value?
• Are your current life choices in line with your values?

Universal: connect to something beyond yourself

• Discover and/or connect to inspiration, enlightenment, peace, theism or life force
• Serve

Ecological: connect to the world around you

• Go outside physically
• Go outside mentally—take a 1 minute vacation and review your senses in somewhere outside that speaks to you (meditation/mindfulness)

Essential: listen to your body and give it what it needs

• Nutrition
• Fitness
• Sleep
• Stress management (Deep breathing/breath work, mind-body bridging)

Intellectual: understand the force behind thinking, deciding, and learning

• Read
• Research
• Take classes
• Therapy

While a relatively new resource in EMS, these teams are trained to provide support and reassurance to fellow members who are experiencing job stress, personal stress, stress from a critical incident, or any type of crisis. Peer support members are not mental health professionals and assistance provided is not considered a substitute for professional counseling.

Employee Assistance Programs (EAP)

• Time-off after hard calls
• Various PTSD therapies (EMDR, ART, CBT, TRE, MBSR)

Professional dounseling

• Intensive outpatient programs
• Private insurance recommendations

State and federal resources

• Safe Utah Frontline (833-372-3325)
• Safe Call Now (206-459-3020)
• Utah Crisis Line (1-800 273-Talk or local 1-801-587-3000)
• Mobile Crisis Outreach teams (MCOT) call 988

https://www.ems1.com/ems-products/fitness-mental-health-wellness/articles/how-to-build-mental-health-resilience-in-ems-EoaXUlRzkeoxxCJz/

A mental health resilience officer (MHRO) coordinates agency support for practitioner mental health and emotional wellness. The MHRO may become skilled at recognizing when someone is at risk. However, the MHRO is not expected nor qualified to diagnose mental health conditions or provide counseling. The MHRO role is to:

• Identify. Notice and name stressors, traumatic events, compassion fatigue, and other factors that may impede a colleague’s resilience.
• Educate. Increase the knowledge and understanding of those around you on mental health resilience and emotional wellness.
• Advocate. Act on behalf of all agency personnel to secure the resources and training required to build and sustain resilience.
• Support. Create an agency-wide atmosphere of mental health resilience and assist peers who may need mental health support by referrals to appropriate resources.

NAEMT created a new education program, the Mental Health Resilience Officer (MHRO) course. For more information, visit naemt.org/education/mhro.

Critical Incident Stress Management Team

The Utah Critical Incident Stress Management (CISM) Program was established to assist emergency service workers throughout Utah. The CISM team comprises mental health professionals and peer support personnel who are trained to assist emergency responders in dealing with the stress of their profession.

The main objective of CISM is to provide crisis intervention during or after critical incidents in order to minimize stress-related injuries to emergency personnel. CISM is both a psychological and educational group process designed to:

1. Lessen the impact of critical incidents to which emergency personnel respond.
2. Accelerate the recovery process of emergency personnel who suffer from stress-related injuries.

Some examples of critical incidents are suicide, death, or serious injury of an emergency service worker; high media interest in an event; a prolonged event; injury or death of a child; a mass casualty incident; threats to an emergency service worker's safety; a natural disaster; or any event that troubles an emergency worker who participated in the event.

We have seen an uptick in seizure transports to PCH. Be sure to check out the Pediatric Education and Advocacy Kit (PEAK): Status Epilepticus, which features an interactive learning module for prehospital practitioners. Since 2021, more than 5,500 prehospital practitioners have completed the interactive module. More than 75% of learners report the lesson to be high quality and better than most online EMS courses they have taken.

Utah EMSC is participating in the upcoming zero fatalities conference which has an exclusive EMS track. We have scholarships for attendance. Save the dates April 24-27, 2023 and contact our program manager jaredwright@utah.gov if you'd like to go on our dime.

The 2023 EMS survey has launched! Utah EMS agencies and Utah PECCs, we have a legacy of getting a 100% response rate on these surveys and that's our goal for 2023. We need your help. Take the survey now and avoid the pleading phone calls from us in March. Click the pic below to get started

2022 National EMS for Children survey results

• EMSC Data Center: EMS for Children Survey National Report

Did you know that without constant use our skill knowledge drops off about 6 months from our last exposure? When was the last time you practiced on your pediatric equipment? Likely it was a PALS class at least 6 months ago. One of the EMSC performance measures is that Prehospital EMS agencies have a process for pediatric skills-check on the use of pediatric equipment.

PECCs, if you need help convincing the higher ups that this is important check out the following article and use these premade resources.

1. Deriving National Continued Competency Priorities for Emergency Medical Services Clinicians
   
2. Pediatric Skills Evaluation Checklists
   • Extremity Bleeding Control
   • Extremity Bleeding Control (Fillable Form)
   • Nasal Atomizer Skills
   • Nasal Atomizer Skills (Fillable Form)
   • Pediatric Airway/Upper Airway Adjuncts Skills-Nasopharyngeal Airway
   • Pediatric Airway/Upper Airway Adjuncts Skills-Nasopharyngeal Airway (Fillable Form)
   • Pediatric Airway/Upper Airway Adjuncts Skills-Oropharyngeal Airway
   • Pediatric Airway/Upper Airway Adjuncts Skills-Oropharyngeal Airway (Fillable Form)
   • Pediatric Airway/Upper Airway Adjuncts Skills-Suction
   • Pediatric Airway/Upper Airway Adjuncts Skills-Suction (Fillable Form)
   • Pediatric Bag Mask Ventilation
   • Pediatric Bag Mask Ventilation (Fillable Form)
   • Pediatric Intraosseous Infusion
   • Pediatric Intraosseous Infusion (Fillable Form)
   • Pediatric Respiratory Compromise
   • Pediatric Respiratory Compromise (Fillable Form)
   • Pediatric Seizure Intervention Skills-Nasal Atomizer
   • Pediatric Seizure Intervention Skills-Nasal Atomizer (Fillable Form)
   • Pediatric Seizure Intervention Skills-Rectal Diazepam
   • Pediatric Seizure Intervention Skills-Rectal Diazepam (Fillable Form)

Do you have a question for our EMSC medical director, Sarah Becker, MD, PCH, ER attending physician about this newsletter topic or anything related to pediatrics? Email tdickson@utah.gov.

Pediatric education for the prehospital provider

Register online at www.peppsite.com. Look up classes in Utah and find the 1 that works for you. Once you find the class, go to jblearning.com, and look up pepp als in the search tool. Purchase the number ($21.95). Return to peppsite.org to register for the class and follow the prompts.

If you have any questions, please email Erik Andersen at erikandersen@utah.gov or text/call 435-597-7098. Continue to watch the website for additional classes.

The Emergency Medical Services for Children (EMSC) Program aims to ensure emergency medical care for the ill and injured child or adolescent is well integrated into an emergency medical service system. We work to ensure the system is backed by optimal resources and that the entire spectrum of emergency services (prevention, acute care, and rehabilitation) is provided to children and adolescents, regardless of where they live, attend school, or travel.

Email: tdickson@utah.gov
Website: https://bemsp.utah.gov/
Phone: 801-707-3763
Facebook: facebook.com/Chirp-UtahDepartmentofHealth