THE BLOG
09/29/2014 08:32 am ET Updated Nov 29, 2014

Dealing With Trauma: An EMT On Coping Mechanisms

EMTs are a ritualistic, superstitious bunch. If it's slow during the day, you count on being plenty busy during the night. Bad calls come in threes. When you get stuck taking a frequent flyer to the hospital (maybe a mean drunk or a seeker), chances are you will transport that same patient to another facility later that day.

There are certain types of calls that are recognized in the EMS world as the big ones, and tradition dictates that when you get a first of these kinds of calls, you buy ice cream. The association is bizarre at first, then becomes customary. First full arrest -- cookies and cream. Delivering a baby -- mint and chip. First stabbing or gunshot wound -- perhaps a rocky road or a simple vanilla. It's not that your station mates want to celebrate the death or tragedy you might have just witnessed; the collective sugar rush marks your evolution in the field and helps to plot the map of your experience, all the while assuring you that you're not alone: these landmarks are known landmarks.

The first bad call is different. It's impossible not to recognize it immediately for what it is: a memory that's going to stick. Images that will become hardwired. A wail you will recall even years later. Bad calls don't ever become customary. They are the jagged, unfortunate spikes within your new normal, and they can return in a flash, lighting up your nervous system with the horror of their memory. Maybe the parent who accidentally ran over and killed his toddler while backing out of his garage. Maybe the spouse who discovered her husband's suicide. The ones left behind are often more scarred than the patients themselves.

When it comes to dealing with bad calls in their aftermath, the EMT ritual is to sit around and talk about it, by which I mean the purest kind of recounting; the only emotion allowed at the table is anger. At times blasé and careless, other times infused with dark humor and a sometimes scathing criticism of the people involved, this kind of discussion tends to search for where things went wrong, or else find assurance that nothing else could have been done: the patient was clearly a goner. We've all done this, I think -- try to find meaning in something that's meaningless, or try to reject a feeling that's refusing to be dismissed.

The way EMTs sit around at station talking about calls reminds me of watching a clump of pigeons fight over something that isn't food. One bird will thrust its beak at the dirty object, shake it and then leave it, only to have another pigeon come up and do the same. This happens over and over again; the object getting attacked remains; no one is any wiser.

On the day I was hired at the ambulance company I used to work for, I asked if there was a program in place for debriefing after stressful incidents. I was told there was. On the night I ran my first SIDS call, my supervisor called my partner and I and asked where we wanted to have coffee -- Starbucks or 7-Eleven. He bought us each a small cup of coffee, handed us pamphlets that had the phone number for depression and suicide hotlines, and then told Dispatch our break was over, we could run calls again. That was the only official debriefing I ever had. I trashed the pamphlet immediately, but not before memorizing the cover photo on the pamphlet, which was of a straight couple laughing in muted light, their edges blurred by the soft focus lens. Another image hardwired.

I worked as an EMT for about three years and the last partner I had helped me find a different system. When we had a really bad call, he never wanted to analyze it, or make jokes about it, or criticize who should have done what on scene to make the call run smoother. What we did instead was sit around at station -- and in my memories now, this was always in the middle of the night, although of course bad calls also happen during the day -- and we would say almost nothing to each other. The television would be off, ditto with the radio. Perhaps there was a pot of coffee brewing or some junk food sprawled out on the table; perhaps not. The main component of this ritual is that in the near-silence, every once in awhile, he would just say, "Wow. That was really bad." And maybe a few minutes would go by or maybe quite a number of minutes would go by before I would respond, saying something like, "Yeah, that was a really bad call." And that was it. We'd sit, in the dark and in the silence, and remember.

The really telling thing is that I don't remember these calls, the ones we didn't talk about. They are the vague muted calls that exist only on my periphery, as opposed to the jagged flashbacks I still sometimes have.

Courtney Moreno is the author of In Case of Emergency.