Help First Responders - National Suicide Prevention Month

From police officers to firefighters, studies show that suicide continues to outpace other causes of death for first responders.

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Today’s blog I focus on these ordinary people called upon every day to do extraordinary things!

We all go into healthcare with a dedication and commitment to help. We take loans for school, we miss our children’s school and recreational events, major and everyday family events and milestones – all to be our best for others.

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With such high stakes - we certainly want to do our best for the people that need our care – whether it’s life-saving actions, bringing in a new life, or helping an old life to feel comfort at the end.

We need to help each other. Be a friend. Stay connected. Ask the questions. Look for help - together.

A white paper commissioned by the Foundation has revealed that first responders (policemen and firefighters) are more likely to die by suicide than in the line of duty. In 2017, there were at least 103 firefighter suicides and 140 police officer suicides. In contrast, 93 firefighters and 129 police officers died in the line of duty. Suicide is a result of mental illness, including depression and PTSD, which stems from constant exposure to death and destruction.
— Ruderman White Paper on Mental Health and Suicide of First Responders
photo: DOUG KANTER/AFP/GETTY

photo: DOUG KANTER/AFP/GETTY

The Ruderman White Paper on Mental Health and Suicide of First Responders, examined a number of factors contributing to mental health issues among first responders and what leads to their elevated rate of suicide. First responders on a call and do not arrive on scene thinking “Maybe I won’t go this time because I might have health or stress issues later.” In just one example 412 emergency workers died responding to the attacks on the World Trade Centers in NYC on September 11th.

Public safety is a difficult profession that can lead to mental health struggles – and those struggles cannot be left untreated. More police officers died by suicide than in the line of duty in 2018, as was the case the previous year and the year prior to that. A study commissioned by the Ruderman Family Foundation found that firefighters are also more likely to die by suicide than in the line of duty.
— PoliceOne.com Jan 2019
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The Code Green Campaign®

In March of 2014 one of our founders experienced the suicide death of a co-worker. In the days after she realized many of the first responders she knew had also lost friends and co-workers to suicide. A small group began discussing the stigma first responders face and what they could do about it. Code Green’s founders agreed that if there is one thing that first responders like to do it is tell stories. They felt that if first responders had an outlet to tell their stories anonymously that might reduce the stigma. This storytelling project evolved into The Code Green Campaign®.

The Code Green Campaign® is a first responder oriented mental health advocacy and education organization. Also known as Code Green, we serve all types of first responders. This includes firefighters, EMTs, paramedics, dispatchers, police, corrections, air medical, and search & rescue. Our name is a combination of the color for mental health awareness (green) and the “code alerts” used in emergency services. If someone is having a stroke or heart attack first responders will call a “code stroke” or “code STEMI”. The idea is that Code Green is calling a code alert on the mental health of first responders.

Additional resources include:

Safe Call Now – 1-206-459-3020
A 24/7 help line staffed by first responders for first responders and their family members. They can assist with treatment options for responders who are suffering from mental health, substance abuse and other personal issues.

Fire/EMS Helpline – 1-888-731-3473

Also known as Share The Load. A program run by the National Volunteer Fire Council. They have a help line, text based help service, and have also collected a list of many good resources for people looking for help and support.

Copline (Law Enforcement Only) – 1-800-267-5463

A confidential helpline for members of US law enforcement. Their website also has additional information on help and resources.

Frontline Helpline – 1-866-676-7500

Run by Frontline Responder Services. Offer 24/7 coverage with first responder call-takers.

Please like and share and check back for more information related to suicide prevention for Veterans.

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September is National Preparedness Month

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The summer is gone with a blink of the eye and now it’s September, already - “Emergency Preparedness Month.” Being prepared is really a year-round activity and when I say “prepare,” I mean in advance, before the emergency arrives.

While different types of emergency situations may require different types of preparation, there is one step that should take precedence – information gathering.

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The first type of information is personal and would include the identification of yourself and every member of your immediate family including full name, age, birthdate, home address, phone number(s), email address(es), relationship and work address for starters. This list should also include family members who live away from you whether across town or across the country. And, when it comes to you and your family, a list of basic health information, including chronic medical conditions, mobility challenges, medications and allergies can be life-saving.

You can make a hard copy for storage in your personal record file or keep it on a thumb drive or other digital media including your smartphone.

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Visit federal, state and local emergency management, suicide and crisis websites for information on local resources and hotlines. Identify the location and non-emergency phone numbers for the closest police station, fire department, as well as the nearest shelter or Red Cross facility.

Having this information gathered, organized and readily available can make a big difference in managing most any type of emergency situation you might face.

Give yourself the peace of mind that comes from having taken this important step in preparation.

We’ll have other preparation tips and resources throughout the month, so please like and share and check back soon.

Do No Harm – It's More Than a Promise

While the phrase, “First, do no harm,” does not appear, as such, in the Hippocratic Oath, it is widely accepted as one of the significant principles under which physicians, and, by extension, others in the healthcare field operate in the practice of medicine.

With few exceptions, those who pursue careers in healthcare, do so from a sincere desire to help others in achieving, maintaining and recovering an appropriate level of physical and mental health. While some clinical interventions can be temporarily painful or unpleasant, there is no intent by the care provider to inflict pain or discomfort on a patient.

FIRST DO NO HARM, by BENJAMIN SCHWARTZ ,  New Yorker Cartoons

FIRST DO NO HARM, by BENJAMIN SCHWARTZ, New Yorker Cartoons

For some of the more routine clinical activities, it takes more than a lack of intent to keep from inflicting unnecessary pain, it takes practice, practice and more practice. And, not just any practice - it takes realistic practice.

For example, take the skill of drawing blood or starting an IV. These are a fairly straight forward activities requiring the clinician to safely insert a needle into the vein of a patient. It is a task covered early in clinical training, but is it practiced as often or as realistically as we believe? Many of us have experienced the real pain and discomfort some providers unintentionally cause when drawing blood or starting an IV.

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Now, some might say it’s “just” a bruise, but in fact, a bruise is an injury producing an area of discolored skin due to the rupturing of the underlying blood vessels. For many it may be “just” uncomfortable and unsightly, but depending on the patient and other medical variables, it may pose a real danger or at least complicate other elements of the patient’s health.

To make good on their commitment to “Do No Harm,” clinical learners and practitioners alike must attain and maintain their hands-on skills to ensure they do not hurt the patient in the process of delivering the care they need.

It was for that very reason ReaLifeSim products were created. ReaLifeSim’s wearable IV training simulator permits students to conduct safe, repeated, realistic practice on a live people (SP’s, volunteers, or each other) to build both the competence and confidence necessary to “do no harm.”

Photo credit: ENA2018

Photo credit: ENA2018

Repetition

When you first start doing something, you focus on the mechanics.

In healthcare, we need repeated practice to move our skills to mastery. And, not just any practice will do - it must be high quality, perhaps perfect realistic practice.

In sports, baseball for example, that could mean swinging the bat over and over and over until you develop the proper mechanics to consistently hit the ball.

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For more than a century, neuroscientists have recognized the existence of “automatism,” which is the ability to perform complicated actions without conscious thought or intention. C. Bergland, https://www.psychologytoday.com/us/the-mysterious-neuroscience-learning-automatic-skills

Automaticity can be achieved by practicing with increasing memory load meaning, purposefully add distractions to your training regimen. It’s about making a newly learned skill a part of who you are, as opposed to just a thing you can do. B. Hardy, https://www.fastcompany.com/how-to-learn-a-new-skill-well-enough-to-do-it-automaticall

Providing the practice and repetition necessary to perfect new clinical skills and develop critical thinking in a safe, observable environment are just some of the many benefits of clinical simulation education.

Providing tools for realistic practice experiences for task training and advanced scenarios is what we do. ReaLifeSim wearable vascular access training simulators - durable, adaptable, portable.

Photo credit: Disaster Medical Solutions

Photo credit: Disaster Medical Solutions

Photo Credit: Pocket Nurse & ENA2018

Photo Credit: Pocket Nurse & ENA2018

How do YOU choose new products?

Most responses will likely include (in no particular order):

  • function,

  • interoperability,

  • realism,

  • durability & maintenance,

  • and of course, budget.

Recommendations from peers and demonstrations at conferences may also influence the decision maker.

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The choices seem limitless with VR and AR and AI and Mixed Reality and Fidelity to fit every need!

Can it still be argued that real practice on real people is the best way to develop real competence and real confidence?

Perhaps it’s best when the two are blended….

"Simulation specialists who add the human component to the simulated experience were found to make the simulated environment more realistic and consequently more conducive to learning caring behaviors." Ward et al., Int J Nurs Clin Pract 2017, 4: 257 https://doi.org/10.15344/2394-4978/2017/257

How can we provide simulated learning on real people without risking injury? This was a problem we decided to solve when we created ReaLifeSim wearable vascular access training simulators.

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Worn by real people to encourage provider-patient communication and add the human dimension, they can also be used as an “add-on” to high-cost high-fidelity manikins for enhanced function and extended sustainability so as not to have to damage costly equipment for routine skills.

But, it can and will be even better:

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“If people would realize how important it is to exploit those aspects of reality that cannot yet be replicated in VR, then we'd be much further ahead in healthcare sim than we are.  Now, take the techniques shown here and add the VR for simulating different training contexts, as we're doing with our Mixed Reality Medical Emergency Response Team trainer and you have a real recipe for success.” Bob Stone, Director, Human Interface Technologies Team at University of Birmingham (UK), credit for above image.

Real practice on real people may always play an important role in developing and maintaining hands-on and interpersonal skills, but advances in clinical simulation are challenging that premise every day.

My "Realism in Clinical Scenarios" Soapbox…

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As recently as in the past few months, I again observed a mock emergency response scenario, and I kid you not - they taped/wrapped IV tubing to the manikin arm saying, “IV started”.

I’m a veteran emergency nurse and educator, an inventor of wearable vascular access products, and I am “a tough stick” when it comes to IVs. That said, here we go…

That kind of limitation, the lack of realism, extends the gap between what we prepare them to do and what they will actually experience regardless of their status as soon-to-be new providers or salty old veterans.

That simple omission feels awfully close to a “pretend you started the IV” situation and we DO NOT PRETEND in clinical simulation.

“In the simulation, it is important to make a simulation experience as real as possible.  This is accomplished primarily by having the students perform the task and not just pretend to do it,” shared S. Howard, Ph.D., RN, CHSE, in “Increasing Fidelity and Realism in Simulation”, 2018, LWW.com.

C. Kroboth, NRP, CCEMT-P, LT, Fairfax County Fire and Rescue adds, “Don’t cut corners here; it’s nearly impossible for students to “imagine” or “pretend” that certain stimuli are present in the simulation when they’re not. Take advantage of all the resources at your disposal using simulated smells, moulage, and even recorded sounds, so that these sensory elements are familiar when they encounter them in the field.”

Of course, there’s always an exception, like when the provider is in a hospital/clinic setting scenario and the patients would have established IVs … but not in an external emergency or disaster situation. The percentage of the population walking around with an established IV is, I’m sure, quite small.

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To be fair - I must also include a sincere thank you to those of you who consistently try to maintain the highest level of realism in scenarios - you know who you are.

There are a variety of wearable products to increase the clinical realism of SPs (our ReaLifeSim products would be some of them), plus manikins that can be programmed to do nearly everything.

Let’s keep it real people - so we don’t do a disservice to those we’re teaching.

Emotional Resilience

Traumatic stress. Compassion stress. Physical stress. Social stress.

Regardless of their place on the responder spectrum of care, everyone from hospice nurse to combat medic can become victims, affected by the incidents to which they respond, day in and day out.

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It’s been said that people in other careers dream about retirement while First Responders just dream of surviving. The environmental stressors and trauma routinely confronted by medical professionals and emergency responders affect their emotions, decisions and actions and we are doing better to prepare the next generations of providers.

From “The Importance of Emotional Resilience for Staff and Students in the ‘Helping’ Professions: Developing an Emotional Curriculum”, L. Grant, Prof of Social Work and G. Kinman, Prof of Occupational Health Psychology, Univ of Bedfordshire, “Educators need to prepare students for the realities of caring work and encourage them to be assertive in seeking out the support they require to protect their own wellbeing, to advocate for working conditions which optimize the wellbeing of their patients and clients.”

The summer conferences are providing a variety of clinical challenges from simulated complicated childbirths to simulated mass casualty scenes taken from the headlines.

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Realism in clinical simulation practice is helping them to identify what they feel and why they are feeling it - in a safe environment, supported by facilitators, instructors, and peers.  

We must continue to provide effective learning experiences that are immersive - simulating a “real-life” situation that can engage the learners’ senses, emotions, thinking, and behavior.

National EMS Week

This is Emergency Medical Services Week.

Why should you care?

Well, given the more than 240 million calls received by 9-1-1 operators each year, in the U.S. alone, there’s a good chance you may be making one of those calls or be the subject of one of those calls in the near future.

So?

So, wouldn’t it be good to know when you call there will be a trained professional always available to answer your call, or the call about your injury or health challenge? And wouldn’t it be reassuring to know highly trained Paramedics and Emergency Medical Technicians (EMTs) are being directed to your location as quickly as possible with the most current equipment, medications, training and communications to provide you the best medical care possible and transport you to an appropriate health care facility quickly and safely?

“Yes,” you said?

Excellent. This week-long recognition event is a reminder, to all of us, of the importance of this vital service we routinely take for granted. Like water and power, we don’t give much thought to them until we turn a faucet or flip a switch and nothing happens! Then we want answers and we want them now.

This reminder is also an invitation – an invitation to attend an “open house;” to learn more how the emergency response system in your community works; contribute to fund-raising activities; participate in public discussions about policies, requirements, staffing, equipping and funding.

Perhaps most importantly, it is a reminder to say “Thank you,” to the thousands of professionals who give of their time and expertise to help their neighbors in need, often as volunteers.

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We, at ReaLifeSim, are proud to partner with the EMS community by providing tools to help deliver the most realistic clinical training experiences possible, so they in turn can deliver the best care with competence and confidence.