For the readers who don't know me I am a
full time Paramedic working out of Canmore, Alberta, Canada. I have been working in EMS since 2003 and before that I worked as a ski patroller in places like Fortress Mountain, Lake Louise, Nakiska, Norquay and now Sunshine Village. Along with first response work I have worked as a river guide for two decades. I have also had the privilege of working with many mountain guides and outdoor professionals in connection with the training I provide and through EMS. Through out my training as a medic and outdoor schools there was little to no education regarding self care and the mental and social derangements that come from experiencing trauma. Over my career things have changed and there is so much more available to us in EMS however possessing trauma is still something that is not addressed in guide training. Experiencing trauma is now recognized as an injury. This is called "moral injury" and its definition covers a large spectrum.
Moral injury is the distressing psychological, behavioral, social, and sometimes spiritual aftermath of exposure to such events. A moral injury can occur in response to acting or witnessing behaviors that go against an individual's values and moral beliefs.
There has now been a shift in the guiding community towards managing the effects of PTSD. The long term effects that come with experiencing bad accidents that have occurred while on the job guiding clients. The moral injury from seeing others in your care suffer injury or death. In EMS we encounter moral injury sometimes on a daily basis. Now recognized as a work place injury 1/3 paramedics are diagnosed with and 100% are presumed to have PTSD. It has become an increased concern within the guiding community. However there is no infrastructure to help guides manage the fallout that comes with the moral injury associated with accidents that they have had to manage.
In all our training as guides or first responders there is plenty of content focused on the actual service and how to manage difficult problems. We are trained in group management, providing progressive skill instruction and how to make good decisions based on the information available. We move through the process of guiding constantly thinking two, three, four steps ahead. Unconsciously we are utilizing a decision making algorithm the OODA loop (Observe, Orientate, Decide Act). It’s is a loop because we do this in repetition. With every positive outcome we gain positive feed back and build on a concept known as eustress. This is where we find our flow state, it can resemble a slow burn or an intense state of performance. This flow of movement through performance is what we rely on to utilize both intuition and calculation. When challenged with the fall out of trauma it can be hard to retain the performance of a flow state let alone do the laundry.
The tools required to mange trauma and its fallout are typically not available or taught to prospective guides. Many of us get into the guiding industry to live our best lives and to share our love for the outdoors and our activity with others. We understand the possibilities but believe that we can manage whatever life puts in front of us or that the worst wont happen to us. More than ever a preamble should be delivered to educate everyone that we need to come to terms with the fact we are working on borrowed time. We will, at some point find ourselves managing rescues, injury or death. We need to come to terms with the idea that to spend 60-100 days per season in extreme environments that there will be accidents.
So naturally there is a gap with nothing to bridge us from exiting a traumatic event and effectively processed feelings. Un processed feelings lead to all the bad things, fear, anger guilt etc.
Harboring all these negative emotions block our ability to enter any flow state or to think critically. Instead focus we tend our thoughts into subjectiveness. Ultimately making us less effective, if at all.
Without formal guided trauma processing our natural response is to build walls, bury experiences away, turn to mood altering substances etc. Naturally this is not effective. Something I have enjoyed about my time in EMS, ski patrol and guiding is the processing of higher acuity calls. It took some time but eventually I leaned that in a couple days I could expect to start recall the details of the event, what went well and what did not. This was also true of the more stressful or taxing rescues or incidents in guiding. Typically these reflections happened during quiet or isolated moments, in the shower, in the gym or driving. This
maybe why I am so drawn towards always having something to distract me. My family loves to point out how habitual it is to have a tv or a podcast running while I do chores-I can’t stand the quiet
The most challenging events in my career has taken months and even years to process. I have worked through anger, resentment, anxiety, depression. These feelings come out of my questioning of my own performance, the performance of coworkers the challenges of the system, or due to the harm that was caused Moral injury can from many different things. One of the biggest challenges for guides would be how it would appear that it was their decision that resulted in the accident if it was in their party. Possibly one of the hardest moral injuries to navigate, causation of harm.
Some things we need to understand in processing trauma is that we can’t control the uncontrollable, hind sight only gives us insight and that processing is exactly that, breaking things down and reconstructing them. The uncontrollable factors in the outdoor recreation world is basically the whole package. The medium on what we travel, the clients, weather, wildlife, gravity etc. What we can control for is our fitness, our skills, training, gear, rehab. What lies in between are the decisions we make. As our risk assessment takes place we may make assumptions about all of our personal accounts and focus critically on all the other factors that are out of our control. As long as we are taking inventory of ourselves then we can make the best decisions regarding that which we have now power. With confidence in ourselves we can rest assured that we can deliver the best experience available relative to people we are guiding and what the environment allows us.
Post incident details may be muddled and unclear, however over time as we recall the events details become more prevalent. There are connections to actions and outcomes that we begin to make and this is where we can really start to build guilt. Guilt is a terrible emotion, it’s paralyzing and depression inducing. Again circling back to our personal inventory, if we are confident that we showed up as our best then we can with confidence push away guilt. While I have been reviewing coping strategies with a good friends regarding lessons as senior paramedics a common theme has been disconnecting from blame. Over time we has come to know ourselves well enough not to assign guilt to performance failures. There is no opportunity to learn when locked into self loathing. It’s ok to feel bad and expect more from yourself however it’s much harder to learn and apply lessons when guilt has gripped you. I have failed a paramedic student for this very issue (I have only failed two students out of dozens). This student would spend so much emotion on failures there was no opportunity to gain insight in between calls. Without the ability to learn from mistakes there is no hope for a long and effective career in EMS.
For others who have seen the worst or had the most terrible outcomes from an outing, the trauma becomes like a film that can’t be washed off. It infiltrates the very tissues of our body. We know now that moral injury and trauma isn’t just a mental injury but it resides in our physiology and can affect our epigenetics.
Currently there is a resurgence in using psychedelics to help reconnect to the traumas that people are suffering with. They are used to immerse the subject in the very event that has caused them harm and process the event with the help of a psychologist. Many of my colleagues have completed this type of therapy minus the psychedelics. The re-immersion can be as simple as putting a uniform back on or as challenging as returning to the very site of the call. For my most terrible experiences both guiding and as a first responder I have shared my experiences and feelings regarding them with friends and colleagues. I spoke of my mistakes and what I learned. And….. I did it a lot! As mentioned it took years to dispel the negative emotions and come to terms. Review of the event and details throughout the therapy takes multiple sessions, especially if there is a lack of personal accountability. The hardest part may be validating feelings of guilt by acknowledging mistakes or misjudgment.
After a big trip or a busy few weeks of instructing I flat line. Basically I get couch locked. I have nothing left in the tank so I take a day or two to just do nothing. I may not always have the opportunity to plan this time but when it comes I take full advantage. I do this because I know Ill be right back at it sooner or later. It is so important to take the time to decompress. Completely step out of your self and detach from any responsibility or activity. Be selfish and do that thing called self care. There is no way you can effectively process trauma without having the energy to do this.
Although I am not formally trained as a trauma counselor all paramedics become counselors to some extent. As a guide working in extreme environments the same is true. Your clients need help in managing anxieties and pushing through their fears from time to time. Soft skills have not been mentioned here but the best guides out there are the ones who have the skills and also know their clients needs as well. Adding another layer to guiding skill is how you should come into this industry. You have to understand that there will be injury to yourself if this is your career, both physical and emotional. No one escapes this simple fact. Be prepared for moral injury.
Find the things that help you escape emotions in a healthy way, exercise, art, cooking anything creative that take your mind off of internal turmoil and stay mentally plastic. Avoid drugs and alcohol as coping coping mechanisms.
When analyzing accidents that others have had keep an open mind and try not to be too negatively analytical, stay humble and give them the benefit of the doubt. Try to learn from the event rather than plainly judge it.
Find ways to process your trauma big and small through reflection and immersion. Talk with friends and family and find a professional if needed.
Keep up on your skills. Knowing your at an industry standard or that your capable of providing the best and safest service possible is a major contributor to your well being and avoiding guilt
Take the time to reflect personally. Make a point to reflect on past events in quiet spaces. Do this often and don't wait for a major trauma to do this. Practice is relevant in everything.
When your getting down on yourself for the mistakes you made push yourself out of that bubble and spend time isolating the things you did well then connect with how you can improve.
Know when your empty. Recharge, and if you cant get help!
Writing this piece has been therapeutic in itself. That just highlights the fact that reflection is soo important in processing. So keep the dialogue open and talk to your friends, watch out for each other and yourself.