As overlapping epidemics worsen stress levels rising for BC paramedics
Wearing a plastic gown, face shield and respirator to protect him from potential COVID exposure, advanced care paramedic Stuart Myers tried to save the life of a young man who had overdosed at a Nanaimo house this summer.
It was, sadly, a fairly typical assignment for someone who works in an ambulance in B.C. today: Paramedics, dressed in full personal protective equipment to defend against COVID-19, respond to a provincial average of 2,000 overdoses each month — a number that ballooned to 2,700 in July.
Although the majority of victims of the poisoned drug supply survive, the calls are tough. And some, like the one involving the young Nanaimo man this summer, are devastating. You can just tell from the raw emotion in Myers’s voice.
“It was my job to make that determination that we are going to stop the resuscitation. We have a discussion with our physician support, and we make that decision that what we’ve done has to come to an end and we have to stop,” said Myers, a paramedic for 31 years.
“It’s that moment for me: having to tell the parent that we’re not going to carry on, that her child has just died. It leaves significant marks. Over the years, listening to people grieve is harder and harder.”
Myers, a regional vice-president of Ambulance Paramedics of B.C., was one of several union members who provided Postmedia a peek inside their jobs on the front line of two overlapping health crises: stark COVID-19 numbers that dipped in early summer but have climbed steadily again since August, and record numbers of fatal overdoses in May, June and July that killed an average of 175 British Columbians each month.
The paramedics who spoke with Postmedia made two things clear: They love their jobs and are intensely proud of what they do. But they are also feeling increased anxiety over the onslaught of fentanyl victims and the constant need to protect their own health, along with that of their loved ones.
“We’ve got the ongoing overdose crisis and certainly it is coupled now with this pandemic — and changing the way we have done our work has definitely led to more stressors. You are feeling the stresses of wearing the PPE,” said Myers, who is also the union’s Indigenous relations officer.
“I’ll be 51 in December. I have risk factors. I’m a single dad. And I certainly worry about my own health.
“And that measure of going from overdose to overdose to overdose is a significant strain on our mental health as well.”
Critical incident stress
The union maintains more and more paramedics are suffering from “critical incident stress” events. Statistics provided by their employer, B.C. Emergency Health Services, certainly show a rise in calls: 1,550 in the first eight months of this year, up from 1,150 over the same period in 2019.
“We have seen, particularly since COVID and overdoses are up, more of our members, paramedics on the front line and dispatchers, all accessing the mental health (support),” said union president Troy Clifford.
Paramedics, he said, learn coping mechanisms to endure a traumatic event, such as a bus crash or avalanche, that might produce several fatalities but ends relatively quickly. What’s happening today is what Clifford calls a “prolonged, mass-casualty incident” that has a mounting number of victims with no end in sight.
Emergency Health Services has tracked whether COVID was the reason behind the rise in critical stress reports by paramedics, and found that was the case in April when managers reached out to all employees who may have been exposed to the virus on the job. Since May, though, the majority of paramedics did not list COVID as the main reason for their increased stress.
A spokesman for Emergency Health Service said the rise in employees’ requests for help appears to be primarily from cumulative stress.
“Like most everyone right now, COVID is adding to the stress,” Shannon Miller said. “For paramedics, that includes rapid changes in procedure, including PPE protocols.”
Paramedics who file critical incident stress reports can access a 24/7 Emergency Health Services program that allows them to debrief with other paramedics or dispatchers who’ve had training in crisis support. They are also given followup options to see trauma counsellors or tap into external mental health counselling for employees and their families. In addition, the ambulance service offers resiliency training and, right now, about 500 employees are taking a COVID-specific resiliency program.
More than 4,000 paramedics, emergency call takers and dispatchers can use the critical incident stress program. In the past, the average monthly uptake was about 135 employees. In the first eight months of 2020, the monthly average increased to 194.
“Our goal … is to continue to focus on supporting staff as much as we can in this environment,” Darlene MacKinnon, chief operating officer of Emergency Health Services, said in an email.
“We will ensure that any of our staff receive the critical support they need. … Our fundamental concern is the safety and well-being of our paramedics, call-takers and dispatchers who are responding with tremendous courage during this time.”
Mentally overwhelmed
Kevan Chesney, a veteran advanced-care paramedic who works in Kamloops, took a block of four days off work in the spring, as the COVID numbers were worsening, when he repeatedly found himself at high-pressure calls requiring specialized treatment, often involving inserting devices into patients’ airways to take over their breathing.
“I personally had to perform some of the most invasive procedures I’ve ever done in my 20 years as a paramedic. Those things, combined with the amount of uncertainty and changing practices literally daily at the beginning of the COVID pandemic, were really, really taxing and led to me needing to take a little bit of time away from work,” recalled Chesney, a member of Ambulance Paramedics of B.C.
“I stepped back from work because I was just kind of mentally overwhelmed.”
Chesney, who has a supportive wife and de-stresses by taking his two dogs along while mountain biking and hiking, felt much better when he returned from his break.
After that, he said, he and his colleagues adjusted well to the new COVID procedures and became adept at quickly donning the PPE. His concerns have begun to rise again, though, with the mounting number of COVID cases over the past six weeks.
“There was a bit of relief over the summer when the numbers had dropped, but now I think there is just a general feeling of anxiety now that the numbers are increasing. Obviously everybody is worried about potentially bringing that home, myself in particular because my wife does have some ongoing medical concerns and she’s a high-risk patient.”
And the overdose calls have also continued in Kamloops, as they have in other B.C. towns and cities. One evening this summer, Chesney and his partner were training another paramedic who was transitioning from primary care to advanced care skills.
The three responded to an overdose in an alley behind some downtown businesses, where firefighters were already on the scene. After donning gown, respirator and face shield, Chesney rushed to help but was shocked by the age of the patient.
“This patient was quite a young female. I think she was in her mid-to-late teens. And just being in that environment: In an alley, and her being alone in that type of a situation where if somebody didn’t find her, her life was at risk. That was trying,” he recalled.
The trio of paramedics inserted an airway device into her throat and then provided positive-pressure ventilation to breathe for her, a procedure that can cause the patient to release aerosols that would carry COVID if she was infected. The girl was then given Narcan to reduce the effects of the overdose.
She survived, but the call remains etched in the paramedic’s memory. “Being there in the middle of the night with this young girl who should be at home with her parents was a bit heart-wrenching.”
‘Which one do you tackle first?’
Shelby Collis, who was raised by a paramedic father and has been following in his footsteps for nearly seven years, laughs when she refers to their profession as the “ugly stepchild of emergency services.” She certainly doesn’t agree with that assessment, but feels like paramedics get less love than doctors and nurses, and less status than police officers and firefighters.
She hopes that will change, especially given the demands of the job today.
“Being at work right now, it’s definitely more stressful than it normally is. With both the pandemic and the opioid epidemic going on, it’s adding more layers to our already overloaded system,” she said.
“We are dealing with the kitchen fire and the dryer explosion at the same time, where there’s these two equally important crises, but which one do you tackle first?”
From Collis’s perspective, more of her calls are for overdoses, but what she wears to every one is affected by the COVID pandemic.
“Our uniforms are already hot and stuffy on a hot summer’s day with our long pants and our wool shirts. Then you add a gown, which is essentially a plastic bag that keeps in all your moisture and doesn’t breathe. Then you add the respirator and you add the shield and you are breathing heavily because you had to go up a five-story walk-up and now you’re fogging up your shield with all your breath,” she says.
“It beats you down physically.”
Still, she is grateful for the PPE because it makes her feel protected. But Collis, 25, is frustrated that her exposure to the virus is going up again and that it is people in her age group who are largely driving up the numbers.
“It is still stressful. You are still putting yourself in a higher risk environment. And you do get those phone calls from the health authority saying, ‘Hey, you did have an exposure,’” she said.
And that’s a worry because Collis has a three-month-old nephew and a relative receiving cancer treatment. “We all have people in our families or in our households that we don’t want to bring anything home to. So it’s just trying to mitigate those risks for us so we feel safe going to work.”
Overdoses in all communities
She is stationed in Burnaby and also responds to calls in Vancouver and New Westminster. Before that she was based in Surrey, where she went to cases stretching from Whalley to White Rock.
“There’s no one community that doesn’t have overdoses happening in it. It’s everywhere. It can be more fatal when you go into nicer areas because people try to hide it from their family members and their friends, because there is this stigma attached to it,” she said.
Collis notes a recent study by the B.C. Centre for Disease Control found people with a history of overdoses are at higher risk of developing severe COVID symptoms because of their other health challenges. Whether an overdose victim is COVID-positive is usually unclear, but she knows that if they are homeless or poorly housed, they are unlikely to own masks or hand sanitizer, and may find it impossible to social distance.
“We have no idea where they’ve been and who they’ve been in contact with. You are in their bubble and if they were unconscious and they all of a sudden spring awake and you are in their face, you are in a very vulnerable position,” she said.
“We all have days where we don’t want to go to work. I’m one of those people — I love my job and I’ve always loved it,” she said. “I was always happy to go to work. I still am, but some days it is harder to put on the uniform and get going because you know you are going to wear a mask for 75 or 80 per cent of the day.”
Cheney, the Kamloops paramedic, comes from a family of first-responders, and gets good support from his relatives. But he also said any appreciation the public shows for paramedics, either in person or through social media, means a lot.
“Any kind of support that we can receive from the public is really important In helping us mitigate the effects of the trauma that we see on the job,” he said.
Chelsey Sharp, who has been a paramedic for 10 years in Kelowna, said one way the public can help is to understand that when an ambulance pulls up to a call, the workers need time to don their PPE before coming inside. She pleads with loved ones to be patient, and notes paramedics have got the routine down to about 60 seconds.
“But It’s an extra minute of listening to a distraught relatives asking us to hurry up,” Sharp said.
“The second that our door opens, we have a lot of people who are approaching the vehicle before we have a chance to get out. We still need our six-foot distance as well, especially when we don’t have any protective gear. And It’s not just for ourselves, but its also for them because we don’t know who we have come into contact with.”
Sharp has young children, and does everything she can to avoid bringing COVID home. Although the gear is cumbersome and irritatingly hot, she is thankful for the protection. And she is extra careful at the end of her shift, removing her uniform in the locker-room before returning home to her family.
Last week, the Health Ministry announced its fall and winter plan to manage COVID, which included 55 additional ambulances and crews for remote and Indigenous communities, as well as buying new monitors and defibrillators for some rural ambulances.
The union says this is good first start, but argues more paramedics should be hired, especially in Metro Vancouver. B.C. Emergency Health Services, though, says there are no plans to hire any new workers in urban areas.
Clifford, the union president, said meetings with the ambulance service continue, and he remains optimistic, arguing more resources are needed to keep paramedics healthy.
Seeing the good, not the sad
Myers, the Nanaimo paramedic, said he has learned a new defence mechanism over his three decades on the job: Rather than get depressed by the weeping of people distraught over the loss of a spouse or child, he tries now to feel privileged to witness so much true love among people.
Still, he continues to be frustrated that in the midst of a global pandemic, British Columbia is still grappling with far too many overdoses, something that he began responding to three decades ago when there was bad heroin on the streets of the Downtown Eastside.
“In my career, I’ve been dealing with overdoses, on a lower scale, from the 1990s, when it was problematic back then, through now. (Today) the fentanyl and carfentanil, you get a bit exhausted doing these calls. It’s sad to watch. It’s horrible we haven’t fixed the problem,” he said.
“Now what we are seeing is because fentanyl and carfentanil are so much stronger, that our resuscitation times are taking us much longer. … A lot of times you are yelling within the masks, so people can hear you. At times I would say it is just a bit of an overload that there are all these things that are going on at the same time. It gets a bit exhausting.”
Myers says he still loves the job, but acknowledges it is taking a toll.
“I don’t know anyone that hasn’t been touched after a hard call. We try to put on brave faces, but at the end of the day they all leave a little bit of a mark.”