Color & Control:

In the eye of the storm: A close up on paramedicine

By Kevin Spurgaitis

Paramedics are the very people who you want—calmly at your side—during a sudden, potentially life-threatening medical emergency. They are the ones called to the scene because others can no longer handle it. They’re trained to calmly take control of and act in the situation, whether it’s to assess an elderly person having difficulty breathing; a middle-aged person who has been hit and injured by a drunk driver; an adolescent following a suicide attempt or a child suffering from anaphylactic shock. Each week they spend hours in intimate situations with patients in ambulances and on gurneys in emergency waiting rooms.

Daily life for those employed in paramedicine is stressful and intense be it paramedics on the ground who are called to any location at any time; their commanders working to ensure sufficient geographic coverage and training; or local dispatchers who take the 911 calls from members of the public.

Recently, in addition to contending with enormous coverage areas and aging equipment, our already-stretched paramedic services, often the difference between life and death, are being further strained due to the COVID-19 (coronavirus) pandemic.

Dave Deines, the president of the Paramedic Association of Canada (PAC), told the Canadian Press in mid March that major paramedic services were already at peak capacity. But he claims that the increase in calls in areas most affected by COVID-19, including those from people with mild COVID-19 symptoms, is taxing paramedic services even more. “The real strain is the extra demand on the system,” Deines said, “Most services are set up to handle a big event in a specific area. Nobody really prepares or can prepare for a country-wide prolonged emergency.”

Life during COVID-19

With every call having the potential of being a coronavirus patient, response and attendance is now taking longer. First responders need to be hyper-vigilant not to expose themselves, their patients or their families to the virus, risking spreading it across communities, according to the PAC, which represents more than 14,000 paramedicine practitioners across the country. What that means is performing longer assessments of patients, donning personal protective equipment (PPE) several times per shift and putting more time into disinfecting their vehicles between calls.

Despite their extra precautions a number of paramedics have tested positive for the coronavirus, the PAC says, but it’s difficult to determine whether or not they contracted it on the job. Others, meanwhile, have had to go off work into isolation because of close contact with patients or family members who have had the virus. There are also reports of paramedics, afraid of infecting their family and friends, staying in hotels and borrowing trailers and camping out in their own driveways.

Long hours and plenty of risk

Typically, the work shift of the average Canadian paramedic is longer than eight hours. Fourteen-, 24- and even 96-hour shifts are not uncommon. So the cumulative stress and nature of their work, coupled with the potential life-saving responsibility that they carry, can take their toll. Self-care and emotional care is key. “Modern day paramedics are at an increased risk of developing post-traumatic stress disorder (PTSD), the experts suggest. According to the Tema Conter Memorial Trust, an organization founded by a paramedic to help other paramedics with PTSD, roughly one-quarter of all Canadian paramedics will be diagnosed with the disorder during and after their careers. PTSD in paramedics manifests in a number of ways: insomnia, nightmares, flashbacks, and inability to cope with life, in general, and job burnout. That, combined with injury, is why fewer than 10 per cent of paramedics continue in the role until they qualify for retirement.

Natalie Harris misses the joys and humanity of the paramedic life in Barrie, Ont., but not the dangers from which she saved patients. Harris was diagnosed with post-traumatic stress disorder in 2014, after being one of the main paramedics at a double-murder call, in which the murderer suddenly became her patient. She then developed what is called a “moral injury,” which caused her world to become rather dark. Thereafter, she struggled with addiction to alcohol and depression.

Paramedicine in Canada

Founded in 1988, as the Canadian Society of Ambulance Personnel, the Paramedic Association of Canada (PAC) is based in Ottawa, Ontario.

Paramedics in this country are certified as either primary care paramedics’ (PCP) or critical care paramedics (CCP) or advanced care paramedic (ACP) who are qualified to carry 20 different medications and are also trained to perform intubation, intravenous therapy, place external jugular IV lines, perform needle thoracotomy, obstetrical assessments and administer pain relief. While qualifications and training may vary by province, ACPs discretionary direct 24 hour access to PCI labs allows them to bypass hospital emergency departments when necessary. Toronto EMS is the largest employer with 850 plus paramedics on its roster.

Wages vary depending on experience and provinces but generally for paramedics the range is $70,000 to $90,000 a year for a PCP, $90,000 to $100,000 for an ACP and $100,000 to $155,000 for CCP.

“I miss my connection to the road and to my patients,” the former first responder wrote in an article for Huffington Post. “I don’t miss feeling the sweat drip down my back under my black uniform on hot, scorching days, but I do miss the feeling of holding someone’s hand when they are searching for a gesture of hope. I also don’t miss not being able to feel my fingers on ice-cold winter nights, but I do miss loading a patient into the back of the ambulance where they will be warm, and placing another blanket on top of them until they finally grin. I don’t miss wearing soaking wet pants and trying to start an IV on a hand dripping with rain, but I do miss finally giving the pain medication they need and the feeling of pride for ‘getting the line’ that was so difficult to get.”

These are some of the stark realities of being a paramedic ‘on the highway.’ But there are peer support programs, which help paramedics cope during the most psychologically taxing moments of the job. So thanks to funding from Tema Conter and training by a licensed psychologist, struggling first responders are only a phone call away from psychological and emotional support, recommendations for mental-health services, and help filing Workplace Safety and Insurance Board claims. The bottom line is that the peer support team makes certain the stigma that has surrounded PTSD in the past does not prevent paramedicine from ever seeking help in the future.

Non-traditional roles

All of these things considered, continued employment growth in paramedicine is expected over the next decade, the PAC says. That’s partly because more and more paramedics are assigned to non-traditional roles in hospital emergency rooms instead of ambulances. But perhaps it’s also the result of changing public perception: paramedics are more than “ambulance drivers offering blankets and oxygen.” After all, in some areas of Canada, paramedics are also trained as firefighters or police officers. In 2005, paramedics were even given the status of Public Safety Occupation like their fellow firefighters and police officers.

And for all of the changes and challenges in paramedicine right now, job satisfaction in this field is fairly high. “The beauty of paramedicine is you have these really intimate relationships that last about 30 minutes, and then you’re done,” says 32-year veteran paramedic, turned trainer, Ian Stoddart. “I like the excitement, the adrenaline rush. But it can come at a personal cost.”


Kevin Spurgaitis has been employed in the Canadian and overseas media for nearly two decades and has written in-depth feature articles on public health, justice and ethics issues. He lives in Toronto.

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