The danger of being an EMT

By ALEX DE LEÓN

My heart is a rock that drops into my gut. The tingling of tiny needles jabs at my fingers. The tingling cascades like the rapping of splayed hands across a piano, up my arms to my shoulders, across my chest and downward, to my waist and my knees and wraps around my toes.

My heart becomes a fist that punches the inside of my sternum. I feel sick. There are tremors, and I clench my fists. My knuckles pop, a searing flash of anger and a reflexive grinding of my teeth. My biceps swell. My core contracts. I’m Hulk. I’m power. I’m ready.

What I’m describing is the activation of my sympathetic nervous system, a defensive mechanism developed over millions of years for people’s survival, more commonly known as the fight-or-flight response.

PHOTO ILLUSTRATION BY NICHOLAS TRUJILLO

For me, this response has become restless. The sting of adrenaline kicks me awake in the morning and it lingers throughout the day. It is as much physical as it is in my mind and it is because of my job.

For the past six years, I’ve worked as an emergency medical technician in Tucson. The job has exposed me to the stark landscape of urban decay in The Old Pueblo.

The streets of our town are rife with alcohol and drug abuse. In many cases, users are left homeless because of their addictions, drifting from urban sidewalk, to convenience store parking lot, to public park.

They are beating other drifters and getting beaten themselves. They hit their heads in a drunken haze and they develop infections. Many have significant mental disturbances and often are unable to care for themselves. They become hardened and hopeless and they end up in our laps, bound for a crowded emergency room.

Some are dangerous.

“He released the center buckle and jumped up and went at me,” says paramedic Peter Chen, 46.

“He began to try to punch, kick, and spit on us,” says EMT Joseph Menke, 25.

“[The] patient got me in the face, then firefighters dragged him off of me,” says paramedic Vivian Kiernan, 25. “It took five people to restrain him … I had a black eye.”

I have been cussed at, spit on, punched, kicked, bitten and generally abused to the point of derangement.

For those of us in public service, including firefighters and police officers, this means that we are always on guard. In a hospital there are escape routes and security staff.

In an ambulance, there is nowhere to run. This leaves us stuck in a metal box with someone who has nothing to lose.

And when there is no flight, there is only one other option.

“I had to fight for my life,” says Jonathan Ellis, 33. “He would have beat me unconscious and/or killed me.”

After repeated confrontation, we become sensitized. We develop what Ivan Pavlov called a “conditioned response.” The stimulus: seemingly unpredictable people, vagrants, addicts and the mentally ill.

Simultaneously, we become desensitized to acts of violence. It becomes more normal to be physical, to use our muscles, to exert power. This keeps us safe, or so the logic goes.

Before working in emergency medical services, I considered myself an affable guy, a funny guy, polite and accommodating. Anger was relegated to the periphery of my experience. Aggression was foreign and antithetical to my nature. Not so anymore.

Where once anger was only a coworker, it has become a friend who has come home with me, rather, a parasite, pernicious and unwanted. It has tainted me and darkened my sensibilities.

I am jaded, pessimistic, anxious and short-tempered. My patience is little and my prejudice simmers just below the surface.

When I hear about a seemingly clear-cut case of unnecessary use of force by a police officer, I know, because of my experience, that that case may not be so clear-cut. Some of these men and women have been damaged, and their seemingly abhorrent behavior reflects the conditioning they have undergone.

Whether they or we as medical professionals would admit it or not, the seething anger that comes over us is the result of fear. We have learned anger and aggression as a defense against hostile forces.

The stakes are higher for police officers who carry a deadly weapon with them wherever they go.

I have a difficult time in public places. I find myself looking around, sizing people up, scanning for potential threats. If anyone remotely fits the description of a dangerous patient, here comes the nervous system reaction: the pounding in my chest, the anxiety, the anger.

It is powerful, and it is uncontrollable. I tell myself that if I do not act on my conditioned response, I am not so damaged. If there is no harm then there is no foul. But on those really bad days, I want to hurt someone.

I feel the need to avail myself upon someone because it feels good. I smother such feelings and am mostly successful. But the dark impulse remains.

I only hope that when the time comes to leave emergency medical services, I can leave the “friend” I’ve made behind. I worry that the change I have undergone will be permanent and that I will never again be the person I once was.

This thought, more than any other, drives me to preserve those gentler parts of myself that have receded to shallow pools along the shore of a roiling sea and leaves me unsettled when I have no task to sufficiently occupy myself.

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  1. dale jansen says:

    Many of us in these professions are indelibly imprinted and changed by what we see and do over the course of years. Our suicide rates are on the rise. No need to be lonely. PTS and PTSD are real despite the naysayers. It doesn’t make us weak. And those who say we get paid well, those who say suck it up, those who scoff, dont get it .
    Reach out. Your friend isnt really a friend.

  2. Tee Cee says:

    You will never be the same as you once were because life serves us the experiences we encounter along the paths we choose so that we may grow. While it won’t always be such a cautious, troubled response to a “normal” environment, you have acquired an insight into humankind that few are privileged enough to gain. Treasure it, grow from it and don’t forget, that while you will eventually leave this friend behind, you will value having known them.

  3. Tom Wright says:

    I feel your pain, and it is pain you feel. I have been in this business for 30 years, beginning in a fire service, then hospital based, then a flight service, and finally back to hospital based. They are all the same. One thing we must all remember is that people only call us on their bad days. Even though, we probably wouldn’t choose to go if they called us just to come by and say Hi…..
    Stay alert, stay aware, and go home safe. You are the most important person to consider when the situation is unstable or unsafe. Your partner is number 2 and the patient somewhere after that.
    I appreciated your article. I serves to remind us that we are more alike than not.

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