It’s OK to Talk about Not Being OK

Many first responders are not feeling OK. They silently grapple with the impact of the traumas they are exposed to on the job, reluctant to go public with their mental health struggles because of the stigma associated with not being constantly ready to answer the next call.

Brandi Beers, DNP, RN, EMT-B, CEN, TCRN
Brandi Beers, DNP, RN, EMT-B, CEN, TCRN

Flight nurse Brandi Beers, DNP, RN, EMT-B, CEN, TCRN, knows the toll that being a first responder can take on one’s mental health. In the Friday session “It’s OK to Not Be OK,” Beers relayed her own story of seeking help after a summer of “accident after accident and trauma after trauma” in hopes it would encourage others to seek the mental health care they may need and to have open dialogue about the issues they face.

Among first responders, 70 percent will seek help for mental health issues if a leader speaks openly about the subject, Beers said. But peers are even more influential.

“Eighty percent will tell you they are not OK if a colleague says they are not OK,” she said.

The impetus for seeking care for Beers was a traumatic day during a season of screams she couldn’t mentally escape after responding to gruesome scenes.

“For some people, it’s the sight, it’s the smell, but for me, it’s the screaming,” she said. “I hear them, I see them, I can feel them.”

She encountered a moral quandary during one of her shifts that only intensified the roaring in Beers’ mind.

“The thing that sent me over the edge, I went, and we were required to do a cervical extraction. I took a healthy human being, and we took his legs off, and I didn’t know how to cope with that,” Beers said. “It wasn’t the mortality or what you see; it was the morality. It’s the quantity versus the quality of life. If that were me, would I have wanted someone to do what they did so that I can live? Or would I rather have all of my extremities? I don’t know.”

But Beers wasn’t allowed to process these thoughts that day. As soon as she returned from that call, she was told to get ready to go out again.

“I was told, ‘You can take a shower, you can have dinner, you have a couple hours for your chart. The night pilot’s coming in, and you’re expected to go,’” Beers recalled.

Her other option was to go home, unpaid, and call the crisis team.

“Nobody can afford not to be paid,” Beers said.

Fortunately, the pilot on duty that night refused to fly with the nurses exposed to the morning’s tragic call, and the company’s medical director reached out to Beers to see what help she might need.

Behavioral health conditions are more prevalent among first responders (30 percent) than the general population (20 percent), Beers said. Contributing factors include sleep disturbances and long shifts, exposure to acute critical incidences, chronic workplace challenges, social conflicts, and lack of recovery time between traumatic events.

“We are the first ones who get to emergency situations. You have repeated, provocative and painful experiences. Like I told you, I had car accident after car accident, death after death, screaming after screaming,” Beers said. “Terrible, terrible. Your mind as a human being, you’re not meant to deal with that.”

The predominant mental health issues among first responders are post-traumatic stress disorder, suicide and substance abuse disorder, she continued.

Multiple interventions are available to help first responders deal with the impact of their on-the-job experiences on their mental health. These include trauma-informed coping strategies, resilience training, peer-to-peer interventions, critical incident stress debriefing and cognitive behavioral therapy.

Eye movement desensitization and reprocessing is a type of CBT that stimulates the brain using eye movement and simultaneous memory recall. It can decrease the emotions associated with trauma and reduce the intensity of traumatic memories.

“I’m most excited about the EMDR. That is what saved me,” Beers said.

Other CBT options are stress inoculation therapy, prolonged exposure therapy and cognitive processing therapy.

Beers recommended the following resources for first responders who need help coping with trauma.