‘We live people’s worst day — every single day’: How EMTs in Lansdale, Pa. battle burnout

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It started out as a typical call for Emergency Medical Technician Brett Szabo.

“This gentleman was short of breath,” Szabo said, “but he was awake and talking to us.”

By the time Szabo had transported him to the hospital though, the patient had died.

“They declared him dead at the emergency department,” Szabo said. “It took me really hard that I was having a conversation with someone one minute, and then the very next minute, they’re gone from this Earth.”

Szabo, who’s worked as an EMT for over 12 years and is studying to become a paramedic, has responded to countless emergencies just like this. But for some reason, this one hit him especially hard.

“I broke down — I truly did,” Szabo said. “I stood in the ambulance bay and had myself a panic attack.”

And Szabo isn’t alone — studies have found that Emergency Medical Services clinicians, which includes both EMTs and paramedics, face a higher risk of anxiety, depression, post-traumatic stress disorder, and suicide.

But recently, the ambulance service where Szabo works — VMSC EMS in Lansdale, Pennsylvania — has been working to address those challenges. Two years ago, VMSC launched a wellness program for its first responders to improve their physical and mental health.

The program is part of a growing shift in the national EMS community away from the stoicism of past years and toward a more open culture — one that was evident as Szabo struggled to recover from his panic attack.

“I was surrounded by the people that understand what was going on,” Szabo said of his coworkers. “They were able to talk with me. I was able to get out why I was feeling the way I did, why I felt like it was affecting me so much more this time around than for the hundreds of other calls that have played out this way.”

Changing culture

When Neil Brady began his multi-decade career as a paramedic with the Philadelphia Fire Department in the 1970s, attitudes were different.

“Early in my career, I think the motto that we were told was to essentially forget the last call,” Brady said. “You had a job to do, you treated the patient, and you were encouraged to leave it behind and move on.”

That mindset has made it difficult for EMS workers struggling with their mental health to get help. John Scheetz, an advanced EMT with VMSC who’s been working in the field for 30 years, says PTSD is a major problem in the industry.

“There’s a lot of things that you see that aren’t the best thing to see, but somebody’s got to see it, and somebody’s got to be there to deal with it,” he said.

The problem is, Scheetz says, until recently, PTSD and mental health issues weren’t something a lot of first responders talked openly about.

“Traditionally, it’s just been very difficult to get any sort of help in this industry, right? Because there’s this whole machismo to the industry of like, ‘You’re not allowed to cry, you’re not allowed to have a problem, you’re not allowed to be injured, or mentally deficient to do the job.’ So the net result is you have a lot of people with a lot of problems that manifest in a lot of different ways. It’s probably one of the reasons why substance abuse is such a big thing. You have a lot of providers that self-medicate, typically with alcohol.”

But the culture has started to change — at least in some places.

Brady, now VMSC’s chief strategy officer, says there is greater openness today than when he was in the field.

“I think people are being encouraged to talk about those situations that affect them significantly that they’re carrying with them to the next call and how to emotionally deal with that,” Brady said. “I think it’s extremely important to be able to clear your mind from that perspective.”

COVID-19 and concerns over provider well-being

Part of that shift seems to be related to the pandemic’s impact on first responders.

“COVID really pushed the envelope for providers, and you saw providers leaving their careers as a result,” Brady said. “And so I think that pushed the envelope to say, ‘We’re recognizing that this talk about mental health affecting providers is a real thing, and look what’s happening we’re not having those folks come back they’ve gone somewhere else, and for those who have stayed we really need to support them and understand how to support them better and let’s explore what that means.”

In fact, around two years ago, Abbey Akins, now a captain paramedic at VMSC, was approached by her chief about starting a wellness committee or initiative. Part of it, Akins says, was related to the emotional toll of the holiday season, but it was also associated with the pandemic.

“COVID was definitely really hard on a lot of EMS workers,” Akins said. “So the burnout rate was just astronomical — a lot of call-offs and just low morale. People were just really struggling to kind of see the reason like, okay, yeah, this is why I do this.”

To better understand how their employees were faring, VMSC sent out an anonymous survey asking about stressors, coping mechanisms, and health concerns.

It found that the top three stressors were work-life balance, personal finances, and personal life. The top three feelings EMS workers reported dealing with were anxiety, fatigue, and depression.

Akins says respondents’ responses varied widely regarding how they coped, but the most troubling strategies included isolation, dissociation, and oversleeping.

Taking a comprehensive approach to wellness

After receiving the survey responses, Akins kickstarted the development of a multi-pronged wellness program designed to address mental and physical health.

“It was almost like triage,” Aikin said. “We all talk about triage when we’re on calls and stuff for mass casualty incidents — like, okay, what’s the top thing that we need to worry about right now? And go from there.”

Among the top responses from the surveys was a widespread desire for increased physical fitness.

“Our jobs are also very physically active, and we don’t always have time to sit and eat a well-balanced meal — most of the time it’s just a sub from Wawa or something,” Akins said.

In response, VMSC secured a discount at a local CrossFit gym, and purchased some exercise equipment for one of their stations.

They also signed up for an Employee Assistance Program that provided everything from therapists to nutritionists, began organizing community events, and even planted their own vegetable garden.

Maybe most importantly, they brought a non-denominational chaplain on board, Dr. Deborah Darlington, to do weekly ridealongs and be available for anyone who wanted to talk through a difficult experience.

“After calls at VMSC, if the crews need a second, we go off status,” Aikin said. “Our community is still covered, but for that specific crew, if the chaplain needs to come in and needs to talk and sit down with us, we can, and it’s a very open discussion.”

Since the program started, Akins says she’s noticed a real change in her coworkers — and in herself.

“When I started the wellness initiative, it was for my coworkers, and obviously myself, but it really helped me get through that point of my life more than I think I let on,” Akins said. “There was a lot of healing within myself that happened.”

Akins said a big part of that was simply making the space to ask how she was doing and being open to whatever answers emerged.

More recently, Akins has passed the torch to her predecessor, Sam Jenks, who was recently named VMSC’s new wellness lieutenant.

“Just battling burnout is going to be kind of our main theme of how can we take care of you, mind, body and soul,” Jenks said. “And how can we teach you to take care of yourself? Because we’re very good at taking care of others and sometimes we forget that we matter as well, or we are the vehicle of this help and care that’s happening.”

A big part of that, Jenks says, is encouraging other EMS workers to be honest with themselves about how they’re doing — and to step outside their role as a caretaker.

“We see people’s worst day and that person will probably live that day once — we live people’s worst day every single day,” Jenks said. “And that’s going to take a toll on anyone. It’s going to be an extra thought, an extra space in your brain. So just remembering that you’re not superhuman, even though everyone treats you like you are and you act like you are. You’ve got to rest sometimes.”

For more about first responders and the health challenges they face, including PTSD among EMS workers, see this episode of The Pulse.