COPYRIGHT AND CITATION CONSIDERATIONS FOR THIS THESIS/ DISSERTATION This copy has been supplied on the understanding that it is copyrighted and that no quotation from the thesis may be published without proper acknowledgement. Please include the following information in your citation: Name of author Year of publication, in brackets Title of thesis, in italics Type of degree (e.g. D. Phil.; Ph.D.; M.Sc.; M.A. or M.Ed. …etc.) Name of the University Website Date, accessed Example Surname, Initial(s). (2012) Title of the thesis or dissertation. PhD., M.Sc., M.A., M.Com. etc. University of Johannesburg. Retrieved from: https://ujdigispace.uj.ac.za (Accessed: Date).
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South African paramedics lived experience of critical incidents: an interpretative phenomenological
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Transcript
COPYRIGHT AND CITATION CONSIDERATIONS FOR THIS THESIS/ DISSERTATION
This copy has been supplied on the understanding that it is copyrighted and that no quotation from the thesis may be published without proper acknowledgement.
Please include the following information in your citation:
Name of author
Year of publication, in brackets
Title of thesis, in italics
Type of degree (e.g. D. Phil.; Ph.D.; M.Sc.; M.A. or M.Ed. …etc.)
Name of the University
Website
Date, accessed
Example
Surname, Initial(s). (2012) Title of the thesis or dissertation. PhD., M.Sc., M.A., M.Com. etc. University of Johannesburg. Retrieved from: https://ujdigispace.uj.ac.za (Accessed: Date).
Appendix 2: James’ Transcribed Interview. The decision was taken that due to space
constraints only one transcript would be included. It should be noted, that in
order to track the themes, the page numbers on the transcript are displayed
according to that found in the Master Theme Table.
Appendix 3: Copy of Informed Consent.
127
Appendix 1: Master Theme Tables:
1. James
2. Paul
3. Sarah
4. André
5. George
James
Master
Theme
Superordinate
Theme
Theme Label Quote/Keyword Page & line
number 1. Experiencing the Trauma of Critical Incidents
Experiencing the Trauma of Critical Incidents
Sensory Experience burnt beyond all recognition/ chunks of meat dripping of him unburnt burnt chunks of meat flesh, flesh, flesh died in crawling position bits of skin peeling in the inside of his ears and nose terrible smell the smell of that particular patient leathery like a cow baked in the sun/touching of his skin was thick, his skin was so thick couldn’t put a drip up touching his skin was like a brick wall, leathery, not cold, not hot, not warm, it was different still talking to us hearing him writhing in agony you can hear it, see it, smell it take all your senses into last one, sight, smell, touch, hearing, taste
Sense of helplessness he was going to die regardless of interventions with burns that severe internal damage is worse so he will die regardless of intervention felt helpless because he couldn’t do anything sense of helplessness very strong feeling of helplessness cause he was alive sent me over the edge last patient was still alive
Empathy he was in pain in back of mind putting up a drip on a burns patient is more painful than normal
4: 94; 97-99
James
Post Critical incident consequences
Re-experiencing the incident Aversion to Burns Patient (Work Performance) Avoidance (wanted to avoid work) Dissociation amnesia subsequent burns pt gone through it before (treating burns pt) seen many burns patients before which never affected me not the first patient seen like that told lecturers and psychologists that he had previously treated burns patients without adverse affect
The TV Show friends think it’s a TV show fill of glory and thrill they don’t realise it doesn’t finish the moment the TV series finishes you have a choice what you want to see you can change the channel in my job I don’t have a choice can’t turn the TV off, have to see, live and deal with it it doesn’t go away it stays there (image stays with you)
Negative experience of working for the EMS organisation
Inherent occupational stressors
everything as a whole EMS and studying Responsibility as ALS (stress) Possibility of death (stressor)/ Going to call (stressor) Medical negligence (stressor general office admin is also stressful I cover a large district which places allot of stress and demand on you scene stress is high as there is less staff/with more staff you are not overworked and overtaxed/have someone in your hour of need Family of the patient
no I don’t (answer regarding if enough support from organisation) I don’t think there’s support at in the work place
15: 406-407 16: 431-432
Seeking help is a weakness
others see seeking help as weakness I became exactly what everyone’s perception was of you if you look for help within the EMS If you seek help you considered weak/you can’t cope kind of thing something insignificant that affected me showing problems could be a sign of weakness I became weak can hide things well considers it a flaw lifelong use of mask no one knew what was going on (explanation): you’ve got own problems I’ve got mine still keep problems to self to this day people don’t need to know about it/no one knows about it therefore it doesn’t make it weak
Isolation at work feels isolated at fire dept as they are all fireman and he works on the ambulance/I don’t fit in because I’m not a fireman I’ve been employed to work on a little yellow bus not a big red lorry
16: 426-430
James
I still feel isolated, like that’s my job and don’t interfere I don’t really get along well with the crew
20: 534
Meaningful work environment
Enduring interest in medicine
lifelong interest “in born” passion passion Can’t just wake up and decide
1: 2 3: 58 12: 303 2: 53 3: 58-59
Ever changing working environment
(not the)same thing over and over not the same/No two cases are the same Ever-changing/New technology/New procedures Not a stagnant environment Not a controlled environment
1 : 3-4 15 16-17;20-21 17-18 3: 67-68
Job Satisfaction a good call ran well from beginning to end where all your basis are covered within the deadline the results you were expecting are the results you get in retrospect it was a good call because you identified the problem, knew the consequences, did something to rectify it and the results were positive use your mind studied to treat the good stuff not the bad stuff accomplish something for the benefit of others I turned his whole life around gives me a sense of accomplishment what my purpose is I enjoy my job enjoy getting down and treating patients
3. Intrinsic factors and active attempts of coping with stress
Perceived need to be in control of the environment
Attributes of a Paramedic
Interpersonal skills young on the edge Adrenaline junky strong personality/determination Empathic, kind, considerate Non-restricted personality/Adaptable and outgoing
1: 7-8 11 12 2: 55 3: 56-57; 12: 305-307
Psychological Hardiness
Emergency field is demanding, strenuous and taxing you got to stand it Can’t let it affect you Recognise strengths, Seek help if need be Handle seeing blood, guts gore
3: 61; 62; 62-63; 63-65; 67;69-70
James
Personal strength strong willed so stuck it out after seeking help I realised it made me stronger it takes a lot of guts, you’ve got to be really strong and stand up and say I need help
7: 174 22: 586-587 27: 720-721
Active attempts at reducing stress
“Closing the Book” you block it out if answer is no then “close the book” (if effort for different outcome possible) if you close the book at the end of the call and there’s nothing you could have done differently leave it closed never open it again if it comes up talk about it so you can close it and forget about it have to forget about it you have to close the book between work, home and friends if you can close that book you don’t have to live with it for rest of your life if the book isn’t closed its an unread chapter without realising it you’ve dealt with it and closed the book (informal debriefing)
doesn’t have to be on a formal basis informally at base generally talking about it even if you sit around in a joking way sitting in a public place you start talking a whole lot more, a whole lot easier we would all sit round the table at the coffee shop the crowd grew at the coffee shop in the mornings it was a ritual someone would say something about a call you would say I had a similar call it’s like a debriefing without you even knowing you debriefing it was wonderful it really was talking to someone helps/relives it subconsciously it affects you where you can’t think about it you have to talk about it once you’ve spoken about it, it becomes easier to deal with (Debrief with family) if it’s close to home only things close to home are mentioned went home told mom it was bad as the mother was roughly the same age as the gran missed granddad so it really touched home spoke to mom stating she had children, what had the child done to deserve that (suicide case involving mother and daughter) you can’t take it home with you I prefer not to talk about things because it makes you look morbid not necessarily interested so why palm it off on them sisters does not understand medical industry/she doesn’t understand my mom and a few of my friends understand
believes having a good cry gets it out getting a hobby I build puzzles and I play piano (hobby) brainless activity like watching cartoons you shut down completely (numbing) get a hobby, do something brainless and just chill (numbing)
Black humour black humour is a personal coping mechanism it’s a personal coping mechanism you are talking about it in a roundabout way other people see it as very undignified
20: 541; 546 20: 542-543 21: 565
James
if you speak to my sister about death they still have to have dignity so it depends on the person you talking to and the type of humour they have she wouldn’t understand (sister) can’t do it in front of family not in front of the family
566 21: 573-574 21: 572 21: 548; 552-553
Psychological treatment the last resort
sought psychological assistance through university saw a psychologist I got sent to a psychologist it was a clinical psychologist when it got to that stage decided needed to see someone (unable to shower with eyes closed) I then decide after what my mom had said I had two choices it was difficult to come to the realisation
Family life affected home life is affected it’s had a detrimental effect on my family your family picks it up you come home and you make home life hell I’d come home grumpy in a bad mood I would be very short, shout allot for something small and insignificant vent my anger on everyone and anyone your fuse becomes very short it got to a stage where I was actually thinking of killing someone in my family
Depression I became very deeply depressed yet again reached the stage where I was suicidal coming home and going to my bedroom and watching TV or play on my computer (withdrawal) I seriously thought of suicide Realise a lot is getting to you was not using medication at time as considers self not usually depressed that’s not me I’ve never been suicidal I’ve never been depressed in my life either I’m not a depressed person/ I’m not one for medication/I’m not a depressed person by nature
number 1. Experiencing the Trauma of Critical Incidents
Experiencing the Trauma of Critical Incidents
Critical Incidents merge
it’s difficult to say.. sometimes.. purely because they all tend to merge into one. you know I’ve had the odd time where I’ve, where I’ve felt that ummm.. ja this is really sad or whatever the case maybe but it’s hard for me to say.. for example that it’s all built up absolutely, that’s bullshit, they do effect you, you just don’t, to some extent there is a large degree of repression and that’s why I say they all merge into one, it’s because you do repress those memories
5: 200-201 6: 213-215 13: 602-604
Don’t find much traumatic
I don’t know the odd thing is that I gotten to the point on the road where I don’t find much traumatic any more you know ummm I certainly in the beginning some of the more messy of the calls got to me you know I have literally seen so much shit that most people would consider traumatic..
5-6: 206-208 6: 212-213
Off duty Traumatic Incident
Personally involved / Off duty Empathy with public
5: 202-206 5:137-141
2. Experiencing in the “World” of EMS
EMS is a subculture
The brotherhood it’s an intense kind of experience it tends to exclude the outside and it creates very much a sub-culture within EMS Protective Proud of subculture Have to earn place Brotherhood Intensity of the shared experience
2: 68-69
2: 70 2: 70-71 2: 71-72 2: 65 2: 66-67
Suspicious of outsiders
they don’t take kindly to interventions from outside.. you know like councillors and psychologists that sort of thing especially if they don’t come from an EMS background they always feel a great degree of suspicion Outsiders don’t understand the demands of the job Fear of seeing through the facade they are not interested in hearing some outsiders opinion it may be wrong or right its neither here not there, they are not going to listen to them,
2: 73-74 / 6: 241-242
2: 74-75
2: 77-79 2: 80 / 2: 82-83 / 3: 86 10: 425-427
Negative experience of the organisation
Inherent work stressors
I mean I used to find the working circumstances themselves more difficult more stressful. shift work lack of growth Non-emergency
ICAS Seen as a punishment As a quick fix but as a human being they couldn’t they don’t care about you in the slightest. Used kind of the just the lack of support from the system/ cannot turn to organisation I got fuck all support from (organisation) .fuck all
the fact that its such an exciting varied working environment no two days are the same long periods of boredom interrupted by short periods of sheer fucking terror It’s not even so much as terror as it is like excitement and the potential for terror you will go from things being very relaxed and easy going.. you get a call and you don’t know what you going to.. and there’s that thrill that bit of excitement also what drew me was the adrenaline Adrenaline junkies Anticipation when receiving a call
skills required making a difference what first attracted me to EMS, was uh partly is that calling, that altruistic side There is something very satisfying in giving part of yourself to be of help to someone else
3:111 / 3: 116 3: 113-114 1: 2 1: 3
3. Intrinsic factors and active attempts of coping with stress
Perceived need for Mastery/control of the environment
Learning to cope the difficulty of the job never lay in the types of things that we saw.. you know because you can learn to cope with that you know uh and sometimes it’s difficult but you can learn to cope with that
6: 215-216 6:216-217
Previous Experience Route/Previous calls done in area Available resources Competence of staff on ambulance
4: 151-156 5: 175-177 5: 179-180
Active attempts at reducing stress
Informal Peer debriefing
for me peer debriefing is always the key just talking about it amongst your friends afterwards.. going for coffee and having cigarettes just chatting about it amongst yourselves.. and that was always something I used to do on my shift with my guys that sort of thing what we do is always clean the vehicles together and while we doing that we also talk about what’s happened if you talk about and talk about it and talk about it enough for me I find that’s how I find a place for it in my head you know not formal
6: 219-221
6: 233-234
6: 239-240
6: 240-241
Paul
Structured internal peer debriefing
I think it would be more productive if it came from someone from within and perhaps if those people had a little bit more training, maybe even on how to identify people who have a major problem who need intervention ummm... that would be, that would be valuable if they can at least identify people who need intervention and can run a basic peer debriefing session itself For me I think what might work would be ummm... peer debriefing that is a little bit more structured you know ummm I think that if you dealing with guys who maybe are interested in for example maybe a peer debriefing course something like that, that might be put together I think that is right you need to get the right person, because not ALS paramedics... because you think ALS would be the most logical choice but not all ALS are that way inclined and not all of them have the people skills for it they really don’t I think it’s more likely to be received if it comes from within , if it comes from within
Humour it’s a staple breaks tension encourages talking talking without being vulnerable emotional release I think there is a time and a place for it you know not in front of public after call at base
Recurrent dreams I have had recurrent dreams, now that you mention it, for years I have had recurrent dreams about dismembered bodies body parts and pieces all over the place sometimes I’m walking through them sometimes I’m driving through them, sometimes at the mortuary, sometimes at a car accident you know, but that’s been sort of a recurrent thing for me for years so you can’t say that it doesn’t affect you at all, I mean I’m not that naive
16:607-608 16:611-614
Wife does not understand.
my wife found my working on the road to be very hard for her the hours in particular being away on nights and weekends, and I think a lot of spouses found that hard like if she needed like if she was battling like if she wanted to commit suicide or if she felt that she had a seizure or whatever the case maybe she wanted me to come home, she couldn’t understand sometimes that no I’m actually busy on a call I can’t come home now you know.. that she found difficulty
14:570-571
14: 577-580
Sarah
Master
Theme
Superordinate
Theme
Theme Label Quote/Keyword Page & line number
1. Experiencing the Trauma of Critical Incidents
Experiencing the Trauma of Critical Incidents
Children are the worst I think for me if you had to ask me about scenes my worst scenes are those with children, those ones are the worst there was a young girl who had fallen into the waterfall at the botanical gardens and she hadn’t surfaced
4: 116-117 4: 122-123
Hoping for alternative outcome
the whole way there we were just questioning are you sure she’s in the water, you sure she hasn’t got out and gonna gotten dressed i was querying if she had not gone home with one of the kids or something like that and I sort of thought to myself I just want to go look in that mine shaft because I pray she has fallen down and she's lying at the bottom and we can pull her out and she’s alive
4: 124-125
4: 127
5: 156-157
Empathising with victims father
the father was on the scene, and at one stage he got very, very aggressive, which it’s understandable it’s his daughter in there. And ummm I think the worst thing was actually pulling her out when that moment when he realised she was dead, that was just... and being a, I’ve got a little two year old baby... and I think that makes it.... watching him hurt was... I’d rather have been in the water so that i didn’t have to see him and watch him hurt the interesting thing that made me feel better he released an article in the newspaper a couple of days later to say that in his religion they can’t blame, they not allowed to blame I think that must have been the hardest thing for him to write but it made me feel allot heck of a better because he didn’t blame anyone
4: 133-136
5: 158-159
4: 141-143
4: 143-144
2. Experiencing in the “World” of EMS
EMS is a subculture
EMS as a clique It’s a clique it really is First ones to stab you in the back First ones to provide support Easily labelled by other paramedics Talking Shop (medicine)
What is your worst call? the one thing I hate that always happens with the public, this thing what was your worst call ever I must drum up the memory of my worst call and tell that person while I’m having dinner Rather not talk about it Don’t want to remember Others intrigued by death/blood
11: 427-428
11: 428-429
11: 429-430 / 11: 441-443 / 11:
448-449 11: 431 11: 431-433 / 11: 436 / 11: 443-
445
Sarah
Negative Experience of the Organisation
Inherent occupational stressor
Shift Exhausted
12: 471 12: 468-469 / 12: 472-747
Meaningful work environment
Adrenaline I like the adrenaline it’s the lights, it’s the sirens, it’s the buzz, it’s the go, it’s the high Crave the adrenaline it’s the whole the race to get there
1: 23 2: 29-30 2:30 2: 32
Maturity I think as you’ve matured with the job the lights and the sirens I don’t put them on anymore unless i have to. I think as you mature you realise that, the speed well is maturity actually saying I’m fine I can deal with it, or is maturity saying you know what that was a nasty one I need to talk. I have the maturity to turn to someone and say you know what i felt it on that call i went wrong, this went wrong, that went wrong what would you have done teach me, I love learning so for me that’s it’s not the lights, it’s not the sirens, it’s not the adrenaline anymore.. It’s treating people its seeing them responding to my treatment.. I think I’m lucky that I’m an older paramedic stable older person
2: 34-37
2: 31 8: 299-300
12: 479-483
9: 353 9: 356-357
Dynamic working environment
the first thing that got me was its dynamic, you don’t go in every single day and check cupboards and count drugs and everyday’s different, its different places, I don’t like the same old thing every single day I was treating in the GP practice at the time it all give them a painkiller give them an anti-inflammatory so it was run of the mill boring stuff different people Learning
1: 21-26
1: 27
Caring for others Care for people it’s the little old lady who you give some pain killers to she turns to you and she goes I’ve been praying for an angle and you’ve just arrived... that’s what it’s all about, it’s all about being able to help someone in that moment they need you, and giving them the right treatment and knowing what you doing is right
12: 476-477 12: 483-486
3. Intrinsic factors and active attempts of coping with stress
Perceived need to be in control of the environment
Need for Control decision was made there and then that I never, I wanted my own protocol, i wanted to be able to make my own decisions and not have to always lean on someone else.
1: 14-16
Sarah
Attributes of a paramedic maturity, dynamic personality, strong personality, confidence, competence good support structure I think all of us are type-A personalities, we all like control
8: 318- 320
2: 67-68
Active Attempts at Reducing Stress
Healthy life style if I’m frustrated there’s nothing I really do, I don’t smoke, I don’t drink, go to gym, live a healthy lifestyle, love playing with my child, love the outdoors, love walking, i will go outside maybe garden for a while or.. just have a little bit of my space just to think eat healthy lifestyle eat well have a healthy lifestyle
6: 235-236 6: 236-237
6: 237-238
8: 326-328
Informal Debriefing with peers
you will find at this academy we will come back and say you know I had this really interesting call this what it was this is what I did, what do you guys think how we gonna change our teaching it becomes an educational thing professional environment I’ll download to my colleagues first before i go to someone professional... I can sit in front of my colleague I can dump on them for 30min about what I’m feeling, they can look at me afterwards and pass the most bizarre comment, and I feel better, they feel better, it’s of my shoulders its finished debrief in terms of what went right and what went wrong
7: 268-269
7: 270-271 5: 181-182 5: 182-183 6: 194-196
6: 206-208
Debrief with Mother Down load to mother just listen there from the beginning first person approached knows the right things to say
Reasons for not using professional psychological services
going to professional people and they will dig up every emotion that wasn’t involved and its 6 weeks of counselling we don’t go to them because of that. if i want to down load I want to sit in front of you, i want to dump on you and if I’m feeling better i want to be able to walk out and say cheers, whereas we will see you in two days time for your next appointment dealing with the specific event only whereas now go and see a counsellor and i must deal with it for the next six weeks, plus unrelated stuff that may come up and everyone has got baggage So you can relate anything to everything, and I, you know it’s, I think that’s probably the biggest problem
6: 196-198
6: 189-199 6: 199-201
6: 203-206 6: 209-211
6:211-212
Humour unable to express true emotions macho man not common at place of work
7: 260-261 7: 261-262 7: 264-266 / 7: 266-268
Sarah
I think the people who are blunted and put on those faces are actually probably the ones who are affected the most, they don’t have someone to turn to, to talk to...
7:278-279
Professional Identity as a protective factor
different person blunted/protected put up the wall blocking
5: 162-163 / 11: 453-454 / 11-12:
454-459 5: 163-164 5: 173-174 5: 174-175
4. Personal consequences of being a paramedic
Personal consequences of being a paramedic
Relationship with son influenced by being a paramedic
overprotective first aid training at school he doesn’t go to anyone who doesn’t have CPR training, doesn’t have first aid. I’m pretty almost pedantic about it, if I go home in uniform and I’ve been working on the road I will literally get in the scullery strip off put something else on and go to my son because I don’t want for two reasons, I have this wall apparently when I wear my blue uniform I don’t need that with my son and I don’t need him exposed to anything I might have picked up,
7: 251-252 7: 252-253 7: 255-256
12:455-459
Car accident had a very bad car accident so I’m not a fast driver i think the biggest thing that happened to me was my car accident.
2: 31-32 2: 45-46
Physical Consequence I ended up in ICU along with two of the other guys in the car had subsequent back surgery which they believe is directly related to it from the whiplash i was in hospital two weeks ago again with my back, I now have total back problems which will never allow me permanently on the road I wasn’t allowed to do anything physical or get in a car for about, I think it was about two months afterwards
2: 56 2: 57-58
2: 58-59
3: 79-80
Psychological Consequences
panic attacks in the traffic PTSD Re-experiencing symptoms: sight (yellow line) : hearing(screeching tyres) : smell (burning tyres) Aversion to driving
Initial thoughts when received call: Worst case scenario.
Can’t be that bad My first thought was you know worst case scenario I somebody’s broken an arm you know
5: 169-171 5: 171-172
Thoughts when arrived on scene: From curiosity to fear.
I was expecting a car, you know the absence of the car made me sort of got me a bit curious when I saw the kid lying there my first thought was oh fuck apprehensive, nervous ummm very, very small amount of fear, scared of what I might find, is probably my first thought processes there arriving there and ja absolute flippen mayhem
5: 186-187 5: 187 5: 189-190
5: 172-173
Thoughts immediately after the critical incident: Elation to anger.
initially sort of some feeling of elation that we’ve done well, well I felt that we’ve done well, everything has gone smoothly, managed our patient I didn’t really think about it that much afterwards it was just another call for that day didn’t really bother me that much a little bit of you know anger especially when we discussed afterwards you know it makes me angry, it makes me very, very angry
6: 217-218
6: 218-219 6: 219 6: 220 6: 220-221
4: 156
Parents are to blame No concept of danger Child is not responsible for the accident
6: 223-225 4: 152-153/4: 161-163
Anger towards parents in retrospect you know afterwards thinking about it afterwards I was very angry with the parents it doesn’t matter which way you slice it it’s still the parents fault at the end of the day, at the end of the day the worst possible thing that could happen to a child is their parents I get very angry, I become very short with the parents in general in my opinion actually the worst possible thing that could happen to them is their parents because its parental neglect to a large extent is the result of many children dying... you know one of my thoughts, one of the things I said to the guys you know that’s the parents fault, we had a bit of a discussion of why I thought it was the parents fault, I very clearly remember the father saying to the garden afterwards you know take that thing and throw it away, in reference to the quad bike my thought ok it was a very brief passing thought my thought then was that it was too late china, it’s far too late, you know that was one of them
4: 150-151
4: 151-152
4:156-157
6: 228 4: 157-159
6: 222-223 6: 223 4: 153-156
André
2. Experiencing in the “World” of EMS
EMS is a subculture
They don’t quite understand
You also tend to gravitate to people who can understand you you tend to gravitate to your own kind you don’t really have time to socialise outside the EMS you know you can’t really relate to people, and they don’t quite understand what is involved can’t understand how you feeling because they haven’t experienced it, it’s literally one of those you have to be there to understand kind of thing
11: 441-442 11: 453 11: 438-439 11: 450-451
11: 451-452 11: 452-453
What is the worst thing you have ever seen?
a lot of what I found a lot of the time is that, meet new people and you get into the what do you do what do you do... and the age old question that drives me fucken bat shift is what is the worst thing you’ve ever seen detest that question... it’s the thing that a lot of people don’t understand is that you don’t want those kind of questions you don’t want to talk about work, you don’t want to tell them about the little kiddie that died the other week because his mother didn’t strap him into his car seat
11: 442-444
11: 444-446
11: 446-447
Negative experience of working for the EMS organisation
Marginal support Outsourced support Support dependant on own initiative Poor support from managers Unable to talk about feelings
No recognition Support from management, there’s no recognition The problem comes in higher up where you don’t get recognition never got acknowledgement for anything, the only thing you got was ahhh you guys are spending too much money or too much overtime or too much leave
Making a Difference sort of I suppose its clichéd but you making a difference it just it makes up for all the bullshit and all the crap just knowing definitively that you’ve really saved someone’s life Wanting to make a difference which is a positive have never encountered anything as rewarding as knowing definitively that you’ve made a difference in someone’s life it’s an experience that I’ve only really, really felt once it’s the best feeling in the world... it really is knowing definitively that you’ve made a difference in someone’s life, knowing that you made a difference with someone’s life you’ve made a difference
3. Intrinsic factors and active attempts of coping with stress
Perceived need
to be in control
of the
environment
Attributes of a paramedic
A type of personality Taking charge confidence assertive, arrogant Solution Focused
2: 41 1: 37 1: 39 1: 34-35 2: 42 2: 42-43
Planning Route Equipment Access to premises Safety
3: 116 3: 120 3: 124 3: 123 / 4: 130-135
Patient Treatment mode then they just sort of kicked in to patient treatment mode... very brief passing sort off... get your shit together and treat the patient... so ja ummm that’s pretty much what happened...
5: 189-191
5: 193-194
Active attempts at reducing stress
Anger I floek I swear more than anything else, swear kind of throw shit around or whatever the case maybe just to sort of get over it I get angry, bit moody and you know it’s done kind of thing... which isn’t the right way to go about it I know
7: 255-256
6: 229-230
Abuse of alcohol I was one of them I was one of those guys who when you looked for your answer in the bottom of the bottle you didn’t do it slowly you did it as quickly as you possibly could there was no such thing as going out to have a couple of drinks to enjoy yourself, you went out and got trashed, that’s all there was to it
7: 265-266
7: 266-267 7: 267-268
Debrief with ambulance partner
you talk about it with your partner even then it’s more a case of you know we did well we didn’t do so well, we could have done this better we could have done that better kind of thing, as opposed to an actual you know how did you feel about this how did
6: 231 6: 233-235
6: 235-236
André
you feel about that kind of thing a coping mechanism by means of just talking about what sort of what you experienced somebody could relate to what you seen to what you experienced so speaking to somebody who you can relate too in that ummm you know they can get a mental image of what the concept is or what you know what the person was seeing what they were experiencing kind of thing relate to it in sort of an emotional level a lot of the times it’s not so much a case of looking for approval or looking for an agreement it’s just a case of talking about it as to what you saw what you did I suppose to some extent is a coping mechanism, ummm talking about it, just get it out, you know see what sort of input come from that
7: 274-276
7: 276-278
7: 278 7: 279-280
7: 281-282
Gallows humour Coping mechanism Inappropriate Finding something funny in the macabre No jokes about children
7: 249-250 7: 252 7: 253-254 7: 254-255
4. Personal consequences of being a paramedic
Personal consequences of being a paramedic
Burn out I was burnt out was tired I very tired from working a lot I worked a lot of overtime not having I mean in the 2 years I was working for Linksfield I think I took in total 4 days of leave... On the road working the whole time I didn’t have it anymore I had no desire to work anymore, had no desire to do calls I actually became one of those people who I detested in that I was one of those people who would argue with the dispatchers and question as to why I was being sent to a particular area... Couldn’t anymore... Personal Relationship affected
8: 336 9: 337 9:372-373
9: 375 9: 378-379
9-10: 379-381
9: 363 9: 337-339
Switching off Not turning off, Unable to separate work life from personal life even like I don’t know you got to like an EMS braai something like that it’s not we’re not talking about our feelings when we talk about calls its almost a pissing contest you know I did an MVA better than the one you did kind of thing, you know the patient was more severely injured than the one you did or I’ve done so many heli calls this week and you haven’t kind of thing so it’s almost a... you don’t talk about it you just kind of make jokes
9: 366 9: 366-369 / 9: 369-372 6: 243-247
It was a progression of factors
so ja it was a progression it wasn’t something that just happened it was a progression... and ja it just got worse and worse and worse you don’t get burnout from one call or one scene or one patient it’s a progression of factors you know, the scene followed by that scene,
10: 385-386
10: 391-393
André
followed by that, followed by that you know it’s a progression of things, it’s not just one call, it’s not just one patient it’s a number of factors...
10: 397-398
George
Master
Theme
Superordinate
Theme
Theme Label Quote/Keyword Page & line number
1. Experiencing the Trauma of Critical Incidents
Experiencing the Trauma of Critical Incidents
Burns patients are the worst
Burns Pt 13: 514-516 / 13: 516-520
Novelty of call Being called to same address twice 4: 147-150 / 4: 154-158 / 6: 212
Uncertainty about treatment
he just didn’t make it... so that’s one of the things you think about, it gives you something that you did that maybe you know could have been different or could you have done it quicker or better type of thing so that’s one thing I think, I mean it’s hardly that you go back to the same address twice you know what I mean [inaudible it was a difficult pt, and you kind of think well is there something else I should have done to this pt or I could have done but in the hours that went past, you kind of think but I doesn’t make sense analyse and reanalyse and analyse and reanalyse and you think maybe I should have done that maybe this maybe that
4: 154-158 / 5: 157-189
6: 224-225
Family Involvement is stressful
... I think also the other thing is the family was involved as well, because the mom and dad were right there... it’s not like your high income people who knows this, you tend to think what you have and you tend to relate it to some people someway... I mean the areas that we go to see pts in, you really kind of feel sorry for the people I think the main thing was that I think the family, because also I had to tell them listen hey your son didn’t make it..
5:194-195 5: 196-198
5: 199-200
2. Experiencing in the “World” of EMS
EMS is a subculture
Public has no understanding of EMS
I don’t think that the public actually knows what we deal with, what we actually do, I think that’s the biggest thing they don’t know the difference between what a fire-man can do, what a BAC, they don’t know the difference, for them its I need help and whoever comes I hope can actually help, and that’s the general, how can I put it, perspective that people have.
3: 95-96
3: 97-100
The negative experience of the organisation
Inadequate support: Nobody to speak to.
Chaplin-runaway counsellors -forced I don’t know put a programme In place considered weak if booked off for stress they have a good support system like that I mean it’s a phone call and the people arrive in 10-20 min, and I think that’s good for the family but like I say... you never use it after a call... you get in your car and bugger off... and there you go and there’s nobody for you to speak to... having a support structure in place Should be part of training
Family at scene Not good when family is there Expectations from family
5: 193-194 6: 201 / 6: 213 6: 221-222
Meaningful work environment
Varied Environment you can go to two resuses and it’s not the same, you can go to two MVA's and it’s not the same ummm, you can go to a shooting now that the guy actual is 100% and the next moment you can go to a shooting and the guy is dead or he is almost dead
2: 38-41
Job satisfaction: Making a difference and training others
making a difference you actually job satisfaction where you can see ja I actually made a difference Pt survives Training others
3. Intrinsic factors and active attempts of coping with stress
Perceived need to be in control of the environment
Attributes of a paramedic strong personality leadership A-Type personality-assertive/control
11: 433 / 11: 437-439 / 11: 447-
448 11: 434 11:435-437
Need for reassurance I think is what I could have done better, could I have actually made a difference that’s what bugs me most of the time you speak to colleagues, for me I need get reassurance still because I’m new in the ALS field for me it’s like maybe I could have done that or used that drug, or how would it have affected the outcome, then speaking to the guys with more experience obviously I actually realise but you know what I couldn’t have, I wouldn’t have been able to make a difference there, did I do the right thing, you know that sometimes bugs you, bugs me for sure, you have I wouldn’t say sleepless nights but you, you kind of go to bed and you sleep and you wake up and you think to yourself you know maybe this or that or whatever could have been different, that happens from time to time, you know just that reassurance that everything’s okay
4: 128-129
4: 129-133
4: 133-136
7: 262
Experience is important that's the thing, for me, it will make me a better paramedic, I can say. Cause you'll always think that experience tells you this, that's what you need to do. Like I say, so the main thing for me is gaining more experience and also making a decision to do the right thing I still need to understand and ummm understand the experience wises that you're going to get the days and you’ll be able to do something and then get the days that you can't do something.
6: 238 6: 239-240 6: 228-230
George
Active attempts at reducing stress
Informal Debriefing with colleagues and wife
Telling the Story Talking to Colleagues Talking to Wife
computer game (alone time) exercise with others Important to have support or something else in place
8: 294 8: 295-296 / 12: 461-463 8: 298-300
4. Personal consequences of being a paramedic
Personal consequences of being a paramedic
Wanting to see more and more
I don’t go hunt for pts anymore that type of stuff... I used to when I started in the service, because then you want to see more and more and more and more you get to a point in your life but you know why, you know its there’s more to life than actually seeing dead people everyday
2: 52-53
2: 54-55
Re-experience emergency scenes
I used to keep an album of like MVA's and things like that, and then obviously you not allowed to show it to the public but ummm.. [inaudible] that car accident was quite a bad car accident, you know if you look at a picture you can recall it instantly, up to the finest set of details you can recall you can drive past a tree where someone was killed, you never forget you always think about it but you not gonna have sleepless nights about it I suppose it’s the same with the album you just take pictures, there’s pictures of everything in there, there’s accidents and there’s good and bad times in there a piece of clothing that can remind you of something, it’s like a trigger I think, like when you drive past a house, for me I just avoid it, try avoid that route sometimes if it was a really bad incident.. so ja... you never forget it’s always in your mind...
2: 62-65
10: 387-388
10: 389-393
13: 507-510
Exposed to the bad side of life
loss of empathy exposed to bad side of life aggression
2: 67-70 3: 106-108 / 3: 109-113 / 3: 113-
114 9: 363-364 / 9: 364-367
128
Appendix 2: James’ Transcribed Interview.
0
Transcription: James’ interview
Date: 30/05/2011
Gender and Race: Male/White
Level of Paramedic: ALS
Years of experience: 8
Age: 27
The decision was taken that due to space constraints only one transcript would be
included. It should be noted, that in order to track the themes, the page numbers on
the transcript are displayed according to that found in the Master Theme Table.
1
Justin: Maybe you can just start off by just saying why you do what you do. 1
James: All-righty ummm medicine is something that has always interested me and ummm as 2
far back as I can remember right back from school days and stuff ok but not the type of 3
medicine that entails sitting behind a desk all day listening to ten people say the same thing... 4
ahhh my nose is running I got a sore throat ja you got a cold go take some of this and go home 5
Justin: Like that Panado ad with the parrot... 6
James: Yes that’s right and one thing that I have sort of... I’ve got very good interpersonal skills 7
and umm I’m very outgoing and I can build relationships very quickly just on my personality so 8
when it was time to sit down and think of a career I looked at a whole lot of things my 9
personality my interests and that kind of stuff and medicine for me was the way to go and as I 10
said it like really interested me and I’m young and I’m kind of like on the edge of the whole 11
adrenaline junky thingy so paramedic was the way to go 12
Justin: How old... sorry how old are you now? 13
James: I’m 27 so that was the way to go, also if you look at it you see a whole lot of things 14
that’s not the same you will never have two cases that are the same so it keeps you on your 15
toes, it keeps you focused, it keeps your mind going all the time and also its an ever changing 16
environment where there is new technology, new procedures get brought in so it’s not a 17
stagnant environment where you got to work every day like accountants got to work every day 18
and count figures and go home and that is their lives, that is their sum total of their lives job 19
where as with with medicine in particular medicine law IT I’m not that kind inclined it its sort of 20
like keeps you on your toes and it’s an ever changing environment 21
Justin: And you started off as BLS? 22
James: I actually didn’t I matriculated and went straight into the Tec, wits tech and I failed first 23
year I’ll be honest I was lazy everyone says party hard, party now study later I employed that 24
approach in first year so I failed due to shear laziness and at the end of my first year I then went 25
and challenged BAA and then got my BAA then went back to first year the following year and 26
then followed through the process from there, worked as a BAA and then registered as an AEA 27
2
then worked as an AEA so I’ve gone through the channels on the two different sides I’ve worked 28
independently in inverted commas as well as understudying with the tech 29
Justin: Tell me a little bit about that how was the studying and that... 30
James: Fucken awful...I kind of felt that mum the tech had it in for me, because if you look at it 31
yes first year I failed out of shear laziness I’ll be honest with you but when I got to second year 32
eventually I was in the running for top student I had the best marks in the class ummm my 33
marks was good my attendance was good yes there were a few weak areas and stuff but at the 34
end of the year when it was time to do finals I failed on my final patient simulation because at 35
the end with the way the tech works and stuff like that by the time you reach second year they 36
start bringing in third year skills and I elected not to do a third year skill in my final sim, and 37
when I challenged it they said to me ok its fine we understand your reasoning behind it because 38
you still didn’t do this kind of thing so I landed up failing the year because of that and I didn’t find 39
it necessary because as I said I was in the running for top student. So that that failed me there 40
and in third year the same thing happened I yet again I was in the running for top student I had 41
the highest marks in my drug tests and everything like that and the only thing that failed me was 42
something like four or five percent in a case study assignment, so that I had to redo the entire 43
year because of that. And when I begged and pleaded you can look at my track record you can 44
look at my academic history from my first year I’m not lazy, my second first year registration, I’m 45
not lazy and they wouldn’t under any circumstances grant me three percent four percent 46
whatever it was that I needed in order to qualify, so out of that sense it was awful, because as I 47
say it took me six years to do a three year degree or diploma and I feel I could have qualified in 48
four, two years unnecessary in my opinion 49
Justin: Yes for sure, what do you think it takes to be a medic? 50
James: What do I think? 51
Justin: Ja 52
James: Well first of all you can’t wake up and decide that you want to become a paramedic, 53
that’s not gonna work, you can do that with law, accountancy book keeping, secaterial but you 54
cant... you got to have a very strong personality you got to have strong determination and you 55
3
got to be able to have that whole like empathy kind of thing behind you and you got to be kind 56
and considerate, but those are like very broad words to use because anyone can be kind and 57
considerate but it’s got to be an in born thing its be a passion of yours it can’t be as I said like 58
wake up one day and decide to be a paramedic, it’s not for everyone 59
Justin: What do you mean by a strong personality? 60
James: The emergency field its very demanding its very strenuous, it’s very taxing so there’s a 61
lot that gets put on you and you got to be able to with stand it and you’ve got to be able to stand 62
up and say right, okay that was a terrible call but I can’t let it affect me and I need to realise my 63
own strengths and that’s that’s the first thing as I was saying you need to realise that and if you 64
need to seek help, seek help and that comes into your personality because a lot of people say 65
oh I’m too if I see a psychologist then I’m weak kind of thing but a strong personality in that but 66
you got to handle what you see, we see blood, guts and gore, we don’t see a controlled 67
environment like a hospital, by the time a patient arrives there we’ve already sorted it out, you 68
see what’s a second part of it and it affects people, and you’ve got to be able to not let it affect 69
you to the extent that it effects other people 70
Justin: What would you ummm classify something that would affect you? So another words for 71
you what would affect you or has something affected you? 72
James: I actually have... its burns patients, I cannot treat burns patients, I’ve seeked 73
psychological help before with regards to burns patients and to this day I still can’t handle them 74
Justin: Maybe can you tell me of a time when you did have to? 75
James: Yup, what steered it on was, I’ve been in this industry since 2004 and you go through 76
it... you see many burns patients and they never ever effected me until 2007 when I was doing 77
one of my shifts and I was doing it in the alberton/ ekulalerni area and that particular night we 78
went to three burns call out and they were just terrible, the first one we went to if I remember 79
correctly, well I can remember correctly [laughs] the first one we went to the guy was he burnt, 80
he burnt in his house, he basically burnt to death and when we go there ummm (9:09) the fire 81
crew was putting out the fire and we went into have a look at the patient and he was lying face 82
up on the floor burnt beyond all recognition and there was like chunks of meat dripping of him 83
4
like unburnt burnt chunks of meat flesh fresh flesh and the smell of that was terrible but I mean 84
it’s not the first time I’ve seen a patient like that, then the night progressed and we went to a 85
second burns patient, and this guy also burnt to death but he burnt in his house and managed 86
to get out of the house and he was like crawling along the floor to get out to where he needed to 87
go and he died in that crawling position so my assumption of that is yes he burnt but he also 88
has asphyxiation and died because of that and the third patient that we saw that night was a full 89
thickness burn 100 percent the guy was in his house and burnt and that I think that cause he 90
was still alive and I think that what sent me over the edge because he was still talking to us his 91
skin when you touched him it was like touching a flippen cow that has been standing in the sun 92
that got backed that thick leathery skin and I mean there was bits of skin peeling off in the 93
insides of his ears and the insides of his nose and he was in pain and I felt so helpless because 94
I couldn’t do anything because his skin was so thick I couldn’t put up a drip he had full thickness 95
burns so he was going to die regardless of what you did he was going to die and you kind of 96
know in the back of your head if you put up a drip on this patient under normal circumstances its 97
going to be painful because you sticking a needle into skin.. you going to feel it when you burnt 98
to that extent it’s going to be even more painful so you kind of feel very helpless in that sense 99
and the smell the smell of that particular patient, and as I said it was all in one night (11:06) that 100
we had that I mean in small doses I’ve been able to handle it but since that night I actually.. I 101
cannot and last year well when that happened I went to go see a psychologist through the 102
university I went to go and see a psychologist and we sort of helped well they had helped me in 103
those days I thought work through the problem and I’ve never treated a burns patient since well 104
I had I had I lie because in 2008 I treated a burns patient the first one sine that incident and the 105
only thing that I can remember about that call was getting out to the call and my mentor saying 106
to me I had two burns patients and the next thing I remember was stepping out of the response 107
vehicle with the fireman driving the response vehicle at hospital I don’t remember anything else I 108
know I couldn’t treat that patient and I remember saying to my mentor saying that I cannot I just 109
cannot and I don’t remember anything there but he got out of the back ambulance treating the 110
patient, and then last year as well I had another burns pt , the guy drank petrol and set himself 111
on fire, and I was the only person on scene until my ambulance got there and I think from what 112
I’ve heard I managed to handle myself quite well on that call but the minute company arrived, I 113
5
left and I remember phoning the last number in my phone that phoned me and I was in a state 114
in an absolute state how I got home I actually don’t know to be honest with you I just got in my 115
car and drove and I’m friends with someone who that’s affiliated through st Johns [inaudible] 116
and she’s a trauma counsellor well she’s a Chaplin actually and when I got home my mom 117
actually phoned her, she booked me of duty for about two hours my mom phoned her she came 118
through, we spoke for about two hours and since then I haven’t treated another burns patient, I 119
actually don’t know but by that time I thought I mean 2008 and 2011 I really thought I was able 120
to handle it but as I say it’s just I can’t if I go to any burns pt instantly I become apprehensive 121
Justin: I’m gonna get back to that just now In uhhh 2007 you said that when you had those 122
three calls those three burns so there was quite a.. or the thing that stuck out for me was that it 123
was three calls so it, so another words it wasn’t just one incident... 124
James: Ja it was three separate incident... 125
Justin: So I’m just trying to find out whether or not it seems like it was like you know like one... 126
it’s like being put on top of each other if you know what I mean... so another words it just 127
became well eventually it became too much just to have that all in one night 128
James: Ja I think so... as I said like you can handle it in small doses I think it will be handled I 129
think I will be able to handle it 130
Justin: So what you saying... ja exactly that if it was just one incident then it wouldn’t really, well 131
it would have mattered but it wouldn’t really have been the consequence wouldn’t have been as 132
great as if it was as like as it was when it was one after the other after the other after the other... 133
James: Ja it’s very possible... I mean I’ve treated burns patients before and I’ve said this to my 134
lecturers and I’ve said this to the psychologist that I was seeing I’ve treated burns pt before and 135
I’ve ever had had an effect of any description towards it so why now 2008 from 2004 is four 136
years in the industry I’ve seen just about everything that you gonna see you know but I couldn’t 137
understand that.... 138
Justin: Ummm who were you working with at that time...? 139
James: I was working with A.P the paramedic on shift that night 140
6
Justin: If you go back to... I mean pls tell me if you don’t want to but that particular night apart 141
from the sight you said also there’s also this is the other thing that I picked on apart from 142
obviously the sight what you saw was horrific but there was other stuff involved and I’m you said 143
one of them was smell is there anything else that... you know that made it particular or that thing 144
besides the sight and the smell anything else that you can pick on how you felt thought or heard 145
that kind of stuff.... 146
James: Well I basically said it’s your sense you can take out the hearing aspect of it for the the 147
first two that we did because the pt was dead but take that last pt that was still alive, to touch his 148
skin I mean you touch normal peoples skin its soft his skin was like touching a brick wall it was 149
hard it was leathery it was not cold but not hot but not warm if you know what I’m saying it was 150
different and then to hear him in he’s writhing in agony you can see it you can hear it and he’s 151
breathing and the smell and everything like that myself personally I just had a very strong 152
feeling of helplessness like I know what needs to be done but I just can’t do it and you kind of 153
know what’s going to happen to him inside you know with burns that nature and that extent you 154
are going to die regardless to what anyone is going to do to you the internal damage is worse 155
so the feeling a sense of helplessness as well so you can basically take all your sense into the 156
last one sight, smell touch hearing taste no really... 157
Justin: But some people even describe it as even the smell in the back of your throat you can 158
almost taste it... 159
James: For months afterwards I don’t know if it was just me but for months afterwards I could 160
smell it on my uniform and I know as I say I don’t know if it was just me but I could and not to 161
sound funny but this is probably is gonna sound funny It got to the stage where it affected me 162
actually showering because I associated that running water with the water of the fires so I 163
couldn’t shower and from that day forth I can’t actually stand with my eyes closed in the shower 164
my eyes have to be open 165
Justin: Because it brings back memories 166
7
James: Ja which is weird because I mean I’m 27 I shower every day of my life [laughs] So I 167
mean it got to that stage and then when it got to that stage that’s when I decided that I actually 168
needed to go see someone about it 169
Justin: What other aspects affected you afterwards besides the showering part ummm I mean 170
the smell on the uniform ummm how did it effect you almost mentally per say that kind of stuff if 171
you can [inaudible] relationships your work that kind of stuff... 172
James: Look with work I didn’t want to go back to work, I actually thought of changing 173
professions from that but I stuck it out because I’m strong willed [laughs] and that kind of thing... 174
but home life and stuff like that I actually can’t remember to be honest with you id lie if I had to 175
tell you I’m not one that’s usually depressed I’m not one that usually goes on anti-depressants 176
and stuff like that so I wasn’t on any medication on that time... 177
Justin: Did anybody come up to you and say like hey you’ve kind of changed or anything like 178
that 179
James: Not really because that also maybe that’s a flaw of mine is I can hide things like that 180
very well I’m for years and years I’ve left this house with a mask on like [inaudible] and no one 181
knew what was going on and when my friends eventually found out they like why didn’t you tell 182
me about this because it wasn’t important you’ve got your problems I’ve got mine and that’s that 183
you know 184
Justin: So you’ve kind of kept it all to yourself, you bottled inside 185
James: Ja and I still do to this day with a lot of things 186
Justin: Would you say that is also part of being a paramedic I mean a lot of people I’m just 187
saying a lot of ummm I’m assuming here perhaps a lot of people bottle this stuff inside... like you 188
were saying earlier if you show it it could be a sign of weakness... 189
James: Yes 190
Justin: The perception is there 191
8
James: Ja I think a lot of people do and that defiantly affects your home life as much as you like 192
to think it doesn’t so I think a lot of people do I’ve had crew members that have come to me and 193
spoken to me and said to me that look that was a very hectic call and I’ve had grown men cry 194
because of it and I’ve personally myself spur it on and say go for it have a good cry because it 195
gets it out 196
Justin: how would what would you say is the best way after a hectic call what would you do it 197
doesn’t have to be burns but I mean anything else uhh to kind of... you know to get rid of all 198
those feelings what would you normally do 199
James: I normally talk to someone about it maybe not on a one on one formal basis but like 200
even over a smoke and cup of coffee back at base like say oh you know I had this call kind of 201
thing and the guy was like seriously fucked, pardon my language, you know and this and this 202
and that kind of thing you know and like just talking about generally subconsciously it relieves it 203
Justin: So you would talk to your peers or your colleagues 204
James: Ja, ja and if, if I notice or depending on the type of call it is it may not affect me but it 205
may affect someone else so I will always go to the people that were with me on that call and say 206
to them id give them the option to talk if they want to they are more than welcome to if they don’t 207
it’s their choice but least they know that that the offer is there if they if they want to and I’ve had 208
one or two crew members just ignore it and I’ve had one or two crew members actually talk 209
about it because everyone’s personality is different so things effect you differently 210
Justin: Sure no defiantly... um what other ways would you say people cope or for yourself 211
ummmm besides maybe talking about it... what else I don’t know... do you talk... besides talking 212
to uhhhh peers do you talk to the family members or to friends about it at all I know you did 213
mention it that you keep it inside so ummm has that changed at all or not really? 214
James: Not really 215
Justin: ok so for you the main way of perhaps dealing with hectic calls is to actually talk to 216
peers about it 217
9
James: Ja I’ve mentioned one or two cases to family or friends but that’s like if I do that it’s 218
close to home if you know what I’m saying like I mentioned to my mom my gran is 82 I 219
mentioned to my mom last year sometime that I did a really hectic declaration where it was I 220
declared some ladies mother who was in the region of the late 70’s and virtually to the day later 221
a year later I declared her father... 222
Justin: Oh my word 223
James: Virtually to the date... it was really weird and they remembered me the minute I walked 224
through the door they said you declared my mother last year and I stood back and then I 225
actually took note of the surroundings and I’m like ja I’ve been here before and I came home 226
and like said to my mom you know that was really bad because last year her mother was 227
roughly that age of my gran and now her father or her father which is... what her grans her 228
grandfather [inaudible] and I lost my granddad at a very early age and I miss my granddad so 229
like it really touched home 230
Justin: So it was a very personal aspect 231
James: Ja and to have that statement made oh like you declared my mother last year kind of 232
thing and it like makes you realise and wonder 233
Justin: Almost sound like a blame statement! 234
James: Yes 235
Justin: So holding you almost personal for the death of the granny in a weird way 236
James: In a weird way so like only things that are close to home will I mention... also kiddies... if 237
I treat a very bad kiddie case I did a suicide the other day, sorry I don’t mean to go into all my 238
cases, I did a suicide case the other day where a mother jumped out a seven storey building got 239
out the window of a seven storey building with her two year old daughter in her arms and both of 240
them were alive when I got there and half an hour later I pulled out a declaration form for both of 241
them and I mean the women was roughly my age if I had to take a guess and I was like talking 242
to my mom saying like you’ve been there you’ve had two kids at two what have they done so 243
wrong that they deserve that kind of treatment I was very angry at that mother very angry... 244
10
Justin: How did you deal with that anger, besides talking to your mom? 245
James: I haven’t [laughs] I still get very angry if I think of it very angry because the kid did not 246
deserve it you know I can understand if the mother did that and did that on her own but the child 247
did not deserve it’s an innocent child 248
Justin: In terms of the emotions going back to the burns part you said you felt helpless hey ja 249
that’s right... ok ja.... ummm... you coming home how do you think it effects your mom talking 250
about this stuff? 251
James: I don’t actually know, my mom funnily enough also wanted to be in the medical industry 252
but due too, She got a hip problem so she couldn’t she can’t stand long hours and that kind of 253
stuff medicine also interests her so I don’t actually think it affect her to much she’s worked with 254
me once or twice before on the odd occasion but she hasn’t shown anything of great anxiety or 255
anything like that to cases that I’ve told her cases that she’s seen this was also for [inaudible] 256
cause I’m the first one in my family in three generations to go in to medicine three or four 257
generations to go into medicine 258
Justin: That’s quite an achievement hey, that’s really good 259
James: Ja so no one else in my family everyone in my family is desk orientated bookkeepers, 260
secretaries, accountants... 261
Justin: Ja umm tell me a little bit about what is the process of when you first get a call what are 262
you thinking what are feeling, till you get there and then afterwards, tell me a little bit about that 263
process 264
James: In my mind what happens when I get a call is I always think of the worst case scenario 265
like for instance if I get a call and its chest pain something simple I always think of it as the pt 266
has got chest pain and they are knocking on deaths door and I’m gonna need to resuss and its 267
its great when you arrive on scene and the tables have turned and the pt is sitting there and 268
talking to you and its minor chest pain and that kind of stuff so I will always I mentally prepare 269
myself for the worst case scenario, but then I also bare in the back of my mind if it’s not the 270
worst case scenario you have to do this cause then you get tunnel vision ok ummm also like 271
11
breathing problems and stuff like that I I think of I think off the worst possible cases where the pt 272
is and then I treat the pt and I stand back at the end of it once I’ve handed over at the hospital I 273
think to myself quickly and briefly is there anything I could have done different ummm if the 274
answer is no, then it basically comes like a closed book if the answer is yes then I’ll keep it in 275
the back of my mind and say what could have been done differently how could it have been 276
done, when could I have done it, and then I’ll keep it in the back of my mind for the next case if I 277
get something that’s similar... 278
Justin: That almost sounds like a bit of a debriefing session in it self 279
James: Kind off 280
Justin: Thinking about what skills I could have maybe used or different skills if there was 281
anything I could have done ummm ja 282
James: Ja cause another thing especially with that I mean when you get to the stage of 283
advance life support people think that you are highly educated and that you are very 284
knowledgeable which should actually be the case but at the end of the day we are also human 285
we’ve got a very large scope we’ve got a large number of drugs that we need to carry and know 286
and there’s no ways unless you read them every single day of your life there’s no ways at the 287
end of two or three years after qualifying you going to know those drugs like you did the day you 288
qualified and people feel weak if they have to refer to their protocol book where as I carry mine, 289
it’s like my bible, I carry mine and if I’m not sure please believe me ill reference it, I I’ve done it 290
before and I’m not shy to do it now to be honest with you I don’t care what people think of me 291
having done that because it shows that I’m stronger than them I’m ready to admit defeat if I 292
need to admit defeat, I’m doubting myself I’m just making sure... 293
Justin: Ummm... you’ve mentioned in the beginning something about uhhh empathy being kind 294
and considerate 295
James: And compassionate yes 296
Justin: or compassionate, sorry, for you particularly after seeing I mean being for a number of 297
years in this industry, ummm how do you keep that because some people would say that well 298
12
because you’ve seen so much you kind of loose your empathy, you know kindness that kind of 299
stuff people maybe just don’t care about other people any more 300
James: You get it don’t get me wrong I mean there are cases where you go to it and say to it 301
ahh God this is the biggest load of croc shit that I’ve ever had to deal with in my life you know 302
but for me it’s my passion, it’s what I enjoy doing as sadistic as that sounds I enjoy my job, I 303
don’t necessarily like the companies that you work for but I enjoy getting down and treating pt’s 304
and my personality comes a lot into that because I’m not a restricted person I’m adaptable and 305
I’m as I was saying earlier I don’t know if it was here or outside but I can adapt to many 306
situations and I’m outgoing I can strike up conversation with someone in the shopping queue ( 307
30:40) that I’ve never met in my life before and I have that ability to do it with pts and people as 308
well and because I enjoy my job it makes it a lot easier but as I said there are case where you 309
go to where you really tired and you know it’s going to be bullshit and you get there and you’ve 310
already got that bullshit attitude like you know what just grin and bear it’s another three hours 311
until the sun comes up and then go to the hospital kind of thing and then you treat the pt like 312
you have to treat them not because you want to 313
Justin: Ja, ja... what do you say for you to protect yourself uuhhhh in terms of like your own 314
mental health if you can call it that, how do you do that, because day in and day out you see 315
grizzly scenes... how do mentally save yourself if I can put it that way 316
James: You’ve got to block it out and if it if it affects you it to the state where you can’t think 317
seem to think about it you have to talk about it that’s what I firmly believe but if you can close 318
that book as I was saying to you at the end of the call if you stand back and say was there 319
anything that I could have done differently if the answer is no you have to close that book and 320
leave it closed and once its closed you should never open it again ok and if it comes up at some 321
stage then you need to talk about it to get to that point where you can close it and forget about it 322
basically because you can’t let it you can’t take it home with you can’t let it affect you to that 323
state as hard and callous as that sounds you actually have to forget about it... 324
Justin: Do you think other people can understand? 325
James: Understand what? 326
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Justin: This type of stuff that you see in terms of like not being in the industry itself... 327
James: I don’t think so because the question that I get asked or a question that I get asked is 328
what’s the most gruesome thing you have ever seen it drives me crazy and another statement 329
that gets made by just about everyone ask what profession [inaudible] you must see quite a lot 330
of things yes I do and you get that relationship between work and home and that’s the 331
relationship I was talking about with the book where you have to close it and yes you do and 332
that kind of stuff and to be honest with you with friends and stuff I prefer not to talk about things 333
because it makes you look all morbid you know, they’ve got their job their profession they not 334
necessarily interested in what you want to do so why must you palm it off on them if you know 335
what I’m saying , take my sister for example she doesn’t understand what industry I’m in, she 336
knows it’s the medical industry and that kind of stuff but she she asks me so do you get a lunch 337
hour... no I don’t I work from 7 to 7 and if I get a chance to eat then I eat kind of thing you don’t 338
have lunch hour like your controlled office job, yes you see it all, and she was like but now if 339
someone did this and you did that how’s it going to be together and how can you not let that 340
affect you, and she’s got a lot of unanswered questions and she doesn’t actually understand 341
where as my mom understands on the other side of the coin and a few of my friends understand 342
but a few of them don’t I mean to them it’s all glory I mean they watch gray’s anatomy and er 343
and when red when code red was on TV they watched all of that it was a thrill for all of them 344
because they get to see it but they don’t realize that you don’t finish it the moment the TV series 345
finishes... 346
Justin: Ja explain a little bit more about that... 347
James: Well you do still think about it I mean the media is broadcast is to or they trained to to to 348
broadcast the sensational aspect of things, the things that people want to see so you have a 349
choice you can either watch gray’s anatomy or not if you don’t want to watch it you change the 350
channel where as my job I don’t have a choice... 351
Justin: you have to see what you see 352
James: I have to see it I got to live it and I got to deal with it and I can’t just turn the TV off if I 353
don’t like what I see, now you have a bad day at the office you have a rip roaring argument with 354
14
your boss, you come home you have a beer you have a glass of wine, whatever you want, 355
depending on your gender and you scream at your spouse and say you know my boss is a 356
bloody idiot, this and that and the next thing and by tomorrow its forgotten, whereas you go to 357
sleep at night, in your mind to got that picture of what you see and it doesn’t go away it stays 358
there... you can bring up a case maybe four five years ago and I probably remember the setting 359
of the case, like the burns patient I described, the guy was next to his shack, crawling down he 360
was wearing a blue t-shirt or blue shirt with like working pants on, black boots I can remember 361
everything the ground underneath him was wet, his right hand was further [inaudible] than his 362
left hand... 363
Justin: Is this something that you think you will have to live with for the rest of your life... 364
James: Yes and no... eventually they will fade, memories fade eventually they will fade, the 365
most important ones or the most crucial ones will stick with you but the insignificant ones fade 366
and if you can close that book, you won’t deal with it if you know what I’m saying you won’t live 367
with it for the rest of your life, so until that book is closed it will be there like an unread chapter... 368
Justin: Well just as a part of the book like the unread chapter no we are dealing a lot with the 369
morbid stuff, maybe you can tell me like a little bit about a good call, something that you felt well 370
what do you consider as a good call? 371
James: I consider a good call a call that ran well from the beginning to the end where all your 372
basis are covered everything was covered within the time deadline and the results that you were 373
expecting were the results that you saw.. I will give you a case to elaborate on that I was a 374
student and I had a case very similar to this recently after qualifying or ja, and the case was a 375
guy couldn’t breathe he had a lot of fluid in his lungs and automatically instinct kicked in I got in 376
the back of the ambulance did what I needed to do got oxygen on the pt, got an ecg on the pt, 377
got a drip up, gave drugs and within 10 to 15 minutes the guy was able to talk to me, from not 378
being able to talk to me and breathing very erratically almost knocking on deaths door with 2 or 379
3 simple drugs I turned his whole life around basically and I remember the last word before we 380
drove of the scene was my mentor turned round to his daughter you have that man to thank for 381
that... and that to me looking back in retrospect was a good call because you identified the 382
problem, you knew what the consequences where and you did something to rectify it and the 383
15
results were positive, and shortly after qualifying I had a case very similar to that where I had my 384
base manager, my branch manager, my area manager, phoning in absolutely hysteria stating 385
that my ambulance crew were on scene and they didn’t know what to do, well they did know 386
what to do but they reached what they could do and they needed further intervention, then I got 387
a phone call to say that the drip has been pulled out, and the crew (38:50) members are no 388
panicking because it was roughly the same situation, so I arrived on scene did what I needed to 389
do got a drip up gave the pt drugs and by the time we, it was here at garden city, and by the 390
time we got to Baragwaneth hospital the guy was able to string a string a sentence together, 391
where he couldn’t string two words together 10min prior, and that to me was a good call... 392
Justin: So again a number of themes there, one is to be able to use your skills 393
James: Yes and use your mind, what’s in your mind as well... 394
Justin: ja so as how do I say it, not one of those bullshit calls, but a call where you can actually 395
use your skills, and then also to know that you’ve, well you’ve saved somebody’s life 396
James: Ja accomplished something for the benefit for someone else 397
Justin: How does that feel for you inside, like what do you feel... 398
James: Myself personally it makes me feel good, it makes me realise why I’m in the industry I 399
am in and it makes me realise what my purpose id, because more often than not you get sent to 400
rubbish, and you got to treat, then you start to think to yourself why did I actually waste 6 years 401
of my life studying this if this is what in gonna treat, I studied to treat the good stuff not the bad 402
stuff, so it gives me a sense of accomplishment like man I did a good job, pat myself kind of 403
thing, now that’s the reason why I’m doing what I’m doing... 404
Justin: Do you think you get enough support from, I’m not saying peers or colleagues but rather 405
the organisation 406
James: No... I don’t... 407
Justin: Ok... Maybe elaborate a bit more on that... 408
16
James: Ok I’m gonna use just because I recently change jobs and I’ve worked for “A” and now I 409
work for the “C”, I’m going to compare them in in the two, I worked for “A” for 13 months in those 410
13 months we cried for about 10, 11 months to get a counsellor in, and it was like brushed 411
under the carpet to say ja ok you know like we will get someone in, kind of thing, and it didn’t 412
really materialise until the last 2 to 3 months that I was working there, then we got a counsellor 413
in and you could see the change, you could see the change in the guys, the moral, the 414
enthusiasm, their willingness to come to work, cause it’s not only.. when you get to that point 415
where something starts affecting you everything affects you, for example if the milk runs out at 416
work, and you like god damnit the milk is run out at work and like you know all I want is a cup of 417
coffee and I can’t even have a cup of coffee and it stresses you out even more, but... and like 418
ahhh grief you know my ambulance is dirty I’ve got to go and wash my ambulance but it take 419
work I don’t feel like washing my ambulance because the sense of pride is gone and after 420
getting that counsellor in at “A” you could see a definite change in the guys, you could see that 421
their moral was a little bit better and there was a little bit more enthusiasm to come to work... 422
Now you go to the Johburg setting the “C” sector of it, and we don’t have that there are 423
chaplains and counsellors available but by appointment, whereas “A” has got one that works at 424
the hospital now, so that’s beneficial cause any time you need to talk you can go find her, close 425
the door and talk, and like with the fire dept, myself personally I feel very isolated their because 426
they are all firemen and I’m an ambulance driver, yes the firemen work on the ambulance, they 427
rotate to work on the ambulance but they want to work on the big red lorry not on the little yellow 428
bus, and I don’t fit in because I’m not a fireman I’ve been employed to work on a little yellow 429
bus, not a big red lorry. And I... yes although I’ve made friends with the guys at work I still feel 430
isolated, like that’s your job that’s my job and don’t interfere so I don’t think there’s support at in 431
the work place 432
Justin: Do you when you work there do they tell you ok well there’s the numbers for this place 433
this place or do you have to actually sorry I’m saying numbers to the Chaplin or... 434
James: No 435
Justin: You personally have to go find that out about that yourself 436
James: Yes ja 437
17
Justin: So do you think the guys, including you make would make use of that... 438
James: I think so... 439
Justin: So if there was a problem they would get hold of the number and phone... 440
James: Yes... but the question is who do you get the number from, it becomes a [inaudible] 441
race, so from having worked at “A” and having friends outside the EMS as well ummm I’ve got 442
a couple of numbers that I use and I recommend these people to, [inaudible] people... I 443
recommend them because they the only people that I know... yes they might not be part of the 444
“C” or they might not be part of the “A”, or something like that, or they might be from a different 445
organisation for example St John there’s a lady that works at St John that’s a trauma counsellor 446
St John is an ambulance service, but she is not affiliated to johburg, she is not affiliated to “A”, 447
she’s not affiliated to “B”, so I mean a complete outsider... 448
Justin: Ja is that important for you to have somebody who’s a complete outsider or somebody 449
to be a part of the, even though St John’s is an outsider they still part they still an ambulance 450
service or there’s a medical component of it, I mean is that important or not really... 451
James: It’s not important aspect is the person needs to understand, and not understand in the 452
sense that, you can go in there and cry your tears of woe and they say it’s ok I understand, they 453
need to understand where you come from initially, and that makes a large difference whether or 454
not they are in the medical industry or not, it doesn’t matter, what matters is they need to 455
understand they need to understand where you coming from why it’s affecting you, to that 456
extent its affecting you and to be able to treat you or help you in the right direction 457
Justin: Ummm besides the lets say the scenes themselves or the medical stuff what other 458
things do you think contributes to the stress, if there are 459
James: There are I’m just trying to think of the right ways to put it... the families would be a big 460
one, but that’s more related to the scenes.. I mean the family is in a state of need they phone an 461
ambulance because someone in their house is sick or dying or what not, and you take 5 min to 462
get there but for them it feels like 5hours, the minute you get there you get screamed at or 463
shouted at why did it take you so long to get here and then by some unlucky charm or unlucky 464
18
chance you land up doing a declaration at the call and the family now is angry because you took 465
so long to get there and if you didn’t take that long my mother wouldn’t be lying dead on the 466
bed, kind of thing, so there’s blame and there’s unanswered questions and... that’s that’s for like 467
the scene thing. Then you can take going to the call as a big stressor because you driving a 468
vehicle at a high speed, you’ve got traffic you’ve got pedestrians, you’ve got the vehicle itself 469
and an accident can happen so quickly, it really can and that’s always in the back of your mind, 470
there’s when I first started off in this industry I used to make sure that I never left work, I mean 471
never left home having had an argument with someone because you never know if you never 472
gonna see that person again and then that guilt that person is going to have to live with for 473
having an argument. I’ve seen it and I don’t wish to do it to my family. So that’s also a big stress 474
and then it’s the stress of actually going to work, because you’ve got your protocols you’ve got 475
your scope and in the back of your mind always is 2 words medical negligence, medical 476
negligence, you miss treat a pt, you miss diagnose something you don’t do something, you can 477
be held liable for medical negligence and lose your licence, and take me for example I’ve got 478
nothing to fall back on, medicine is my life vie matriculated went straight into varsity, I’ve got 479
nothing else to fall back on and I’m 27 28 at the stage where I’ve now got to start setting up a 480
family, let’s just take worst case scenario, I get found to be medically negligent for something I 481
lose my licence I now have to start studying again, I’ll have no job I’ll have a family to support, 482
which which career do I go on to... people aren’t looking for companies aren’t looking for people 483
that are 50, 60 years old, they are looking for people that are 20 30 years old.. so it’s a big 484
concern of yours as well... and then like just the general office environment of being at work, 485
you know you’ve got deadlines, you know you’ve got performance cards to do, you know you’ve 486
got statistics to do, you’ve got stock to order and if it doesn’t get ordered you start running out of 487
stock you start getting stressed because you don’t have the required equipment to treat your pts 488
Justin: Seems a lot of, quite a bit of responsibility 489
James: Yes very much so... 490
Justin: From ok this is gonna sound kind of obvious, but I mean do you work as BLS before 491
hey, if I’m correct? 492
James: Yes vie worked BLS, ILS ALS... 493
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Justin: Ok so would it be fair to say, the higher the grade the higher the stress 494
James: Yes definitely, because even if you look at it from the different practionar side of things, 495
i mean as a BLS on your little card its registered supervised practioner which means you can 496
basically do what the hell you like because someone more qualified than you is going to step in 497
and stop you, the chances of you being found medical medically negligent is slim because a) 498
your protocol is small and b) you’ve been watched then you get to the stage of intermediate life 499
support where on your card its written independent practioner so now your it for the ambulance 500
but you still got an escape route with your ALS because on the same scene your ALS will 501
watch over what you’re doing and say to you look [inaudible] you doing something wrong, let’s 502
look at it from a different avenue kind of thing, so you’ve still got that piece of mind behind you 503
but as an ALS paramedic you have now reached the top, and you are it... you need to make 504
sure that everyone on scene is doing the right thing, you need to make sure the scene is safe, 505
you need to make sure that the base runs smoothly, you need to be able to be there for your 506
crew ummm as I’ve said earlier you are very highly regarded when you get to ALS because 507
people think you are this world of knowledge and this very highly educated person whereas 508
back at the ranch you may not necessarily be I know people out there that I won’t allow near my 509
family with a barge pole.. so it’s, it’s a lot of extra stress being an ALS paramedic as opposed to 510
being an ILS and BLS paramedic... 511
Justin: So there seems to be less support in a way if you know what I mean 512
James: Yes.... 513
Justin: Ummm... what do you think the organisation could do to give you more support...? 514
James: That’s a little bit of a tough question... 515
Justin: Well whatever comes to the top of your mind 516
James: The first two things that come to the top of my mind is employ more staff and have a 517
counsellor on standby, I mean if you look at the areas that you service myself personally I cover 518
a very large district working at Joburg I covered a very large area working at “A” and that in itself 519
places a lot of stress and demand on you as an individual, and if you employ more staff it takes 520
20
the stress of of you, I mean we were talking at work the other day and the guys were saying 521
back in the days in nineteen foetsack, there were 3 ambulances and 2 response cars that ran 522
from Fairview fire station, and there were 16 to 20 people on shift a day and they had three fire 523
engines that ran from one station, now you’ve got 2 fire engines one ambulance and one 524
response car and ten people on shift, so you’re on scene stress your at work stress is incredibly 525
high whereas if you can have a lot more staff it evens the stress out a little bit because you not 526
that overworked so to speak, overworked and over taxed. And to have someone to talk to to 527
know that you’ve got someone that gonna comfort you in your hour of need... 528
Justin: Who are you able to talk to know at, you don’t have to mention names or anything, but I 529
mean is there somebody that you can talk to at Fairview or not really... 530
James: There’s only really one or two guys that will like, without sounding racist or anything like 531
that but there’s including myself four white guys on shift and one black lady all the rest are black 532
men, and there’s one white guy that I can speak to and possibly the black lady we could speak 533
to, I don’t really get along well with all the crew but those are the two crew that I get along the 534
best with.. 535
Justin: Just in terms of my research one of the besides talking to peers one of the other ways of 536
coping with stuff is uuuhhhh what they call black humour, so almost macabre jokes about stuff 537
like that.... 538
James: Ja we kind of do that too [laughs] 539
Justin: Tell me a little about that... 540
James: I think that’s a personal coping mechanism for a lot of people because in a way it looks 541
like you in a way myself what I think and feel about that is in a way you are talking about it but in 542
a roundabout way not letting people know that it affects you, so you go and say Geeezz that 543
dude was burnt to a crispy last night did you check him I mean like if you broke his toe of it 544
would have gone crack kind of a thing. I mean ja it’s terrible and it’s sick to joke about stuff like 545
that but it’s a personal coping mechanism in my opinion... 546
Justin: When, when can you do this and when cant you do it... 547
21
James: You can’t do it in front of the family [laughs] 548
Justin: There would be no appreciation there... and if there was I would be worried [laughs] 549
James: Very much so... I suppose you can do it any time provided the time and place is right, 550
back at base over a cup of coffee and cigarette or back at base at the end of hand over or if you 551
got other people in the car you can make a joke going from one case to the other but like not in 552
front of the family, it will offend them. Now I did something like that once it was embarrassing, I 553
did a declaration and it was a taxing declaration ill be honest with you and ummm we phoned 554
the mortuary van and I waited and I helped the guys load the pt, as we were loading it into the 555
back of the hearse I didn’t realise that the family had followed us out of the house and as we 556
were loading the pt into the back of the hearse, the undertakers cell phone rang, and it rang and 557
it rang and it rang and it was loud, and nit thinking twice I just turned around at the most 558
inopportune moment and I said geez your phone is ringing so loud it can wake the dead, 559
[laughs] you know, and I said it with like the straightest face as a joke, and I didn’t realise the 560
family was standing right behind me, so that was a very inopportune time, so that doesn’t 561
definitely have a time and place for anything like that, I was very embarrassed and very 562
apologetic, and all I wanted to do was stick my head into the ground 563
Justin: Ummmm... besides that do you think friends and family understand black humour? 564
James: No because they could then see it as very undignified, take my sister for example if you 565
speak of death to her she’s like they got to save their dignity and they now have passed away, 566
and that’s the end of it, that’s nothing for them, but it’s for my sister I would never go to my sister 567
and say geeez I did a crispy on the highway last night or I did this spread on the highway last 568
night and I stood on a piece of brain, because it would send her over the edge to be honest with 569
you because in her opinion that pt is dead and they should, although they died in a very 570
undignified manner they should still have the dignity they deserve, which I understand so she 571
wouldn’t understand that but let’s just take my mom for example she would, she’s got a very 572
wicked sense of humour like I do, so it also depends on the person you talking to and the type 573
of humour they have 574
22
Justin: Ummm what do you think the chances of, ok I know you’ve sort help, was it difficult for 575
you to actually look for help in terms of like, I know you came to the realisation but I mean was it 576
difficult for you to sort of look for help 577
James: Initially if I had to go back to that burns incident that I was referring to earlier when it was 578
the first time that I sought help, yes it was because I became weak, if you know what I’m saying, 579
I became exactly what everyone’s perception was of you if you look for help within the EMS 580
Justin: Ok...ummmm oh ok so you saying others people’s perceptions or even you thinking I’m 581
weak, that’s why I have to look for help... 582
James: Ja cause as I said to you like if you seek help you considered weak and like you can’t 583
cope kind of thing (58:10) but after having seeked help, ja it was difficult to to come to the 584
realisation and actually go to someone and say look you know I mean this call has affected me 585
it was something insignificant it has affected me and I need help, but after having sought the 586
help I realised at the end of the day it made me a stronger person... 587
Justin: What do you personally think would change that perception in the EMS... but just 588
because I need help doesn’t mean I’m weak you know what I mean what do you think could 589
change that perception? 590
James: Is if help was already available because you find you would that you would be speaking 591
to them without even knowing it and you wouldn’t be considered weak so if you could have that 592
available to you, if the help is more readily available and I mean yes you still have your 593
confidential times behind a close door but even if you just sit around in a joking way I mean the 594
lady that I refer to from St John’s she is really sweet lady she’s wonderful she’s brilliant, you can 595
sit next to her and say like I did a really bad call or you know I declared a kid the other night and 596
she will say one or two things only and it will put your mind at complete rest like you did all you 597
could or deep down inside the mother was probably hurting just as much kind of thing as what 598
you are now and she needed to get rid of but she never had someone to talk to, so had she and 599
then the kid would have still survived kind of thing or on those lines, she says it in the sweetest 600
of ways and without even realising it you’ve dealt with it and closed the book, and I think and I 601
mean that’s sitting in public not necessarily behind a closed door its sitting in a public place in 602
23
amongst other people you just start you find especially with her you find you start talking about a 603
whole lot more a whole lot easier and your crowd gets bigger at the end of the day. Going back 604
to “A” days it started off where she was there and you have one or two people that came and 605
that kind of thing and then in the mornings it would be this huge big ritual that we would go to 606
the coffee shop and we would all sit round the table at the coffee shop and we called her mom 607
quite literally, cause she’s old enough to be my mom and we called her mom and we all just sit 608
there and joke and laugh and like someone will just crop up and say something about a call and 609
you say you know I had a call like that similar to that you know and you talk about and half an 610
hour later you order another cup of coffee and then half an hour later you all go on your merry 611
way kind of thing it’s like a debriefing without you even knowing you debriefing and the crowd 612
grew at the coffee shop and that was like our meeting place every day, it was wonderful it really 613
was... 614
Justin: Any particular negative ways that you may have dealt or started to try and deal with that 615
particular those burns those burns pts that you saw like any negative ways that you may have 616
dealt with 617
James: In what sense? 618
Justin: Like for instance like I interviewed a particular person and I’m not saying this is for you, 619
he started drinking heavily, that kind of stuff, I don’t know if that ever happened with you at all... 620
James: Not really, but I will say one thing that’s that’s had a detrimental effect on my family life 621
and my personal life is , from everything as a whole taking EMS and studying at that stage and 622
everything as a whole, I did become very deeply depressed it got to a stage where I was 623
actually thinking of killing someone ok someone in my family and then I got sent to a 624
psychologist I think it was a clinical psychologist we worked through issues, and shortly after 625
that this particular family member of mine happened to pass away and I had deep regret and I 626
didn’t think I that it would affect me as much as it actually did it affected me very badly, because 627
of history and the thoughts, and I actually said to this person you you’ve got a telephone 628
number to phone and thank because the person on the other end of that line is responsible for 629
you standing here today and not me killing you, and it got very nasty because of that and for the 630
last 4 5 months, ok this person has been deceased for a year and half but for the last 5 months 631
24
I’ve been on a course of antidepressants, from like everything in general because I yet again 632
reached the stage where I was suicidal and that’s not me that’s I’ve never been suicidal in my 633
life I’ve never been depressed in my life either.... 634
Justin: And that was [inaudible] what you’ve been telling me seems to be not only from the 635
actual work but also, ok I’m just trying to understand it more the work itself influenced the family 636
life 637
James: Yes 638
Justin: And but then it’s kind of amalgamated in a way in terms that the work and the family life 639
increases the stress, if that makes sense and 640
James: Yes 641
Justin: does that make sense? 642
James: It does... 643
Justin: And then because of that increased the depression 644
James: Yes because... 645
Justin: Am I saying it right 646
James: You are... 647
Justin: Ok 648
James: Umm because as I said I’m not a depressed person I don’t I’m not one for medication 649
and one for antidepressants I’m not a depressed person by nature, but your family picks it up 650
that there’s something now that’s affecting you, and its work let’s be honest I mean the reason 651
why I’m on antidepressant now at the moment is because of work, and you come home and you 652
make home life hell ok and you don’t realise that you are doing it, and it affects those around 653
you and those around you will say something to so you concentrate more on trying to increase 654
the attitude or the atmosphere or better the atmosphere at home and that also places an 655
incredible amount of stress on you because you now trying to please everyone and... 656
25
Justin: Which in a way is not how you feeling so it’s false? 657
James: Exactly and you can’t please people, you have to be this is me, you either like me or you 658
don’t you know and take me with a pinch of salt if you want to I really don’t care but you 659
pleasing someone and you not pleasing them up to their expectations so you work harder and it 660
puts extra additional stress on you so they do kind of like join and amalgamate as you said... 661
Justin: It’s like a snowball affect almost... 662
James: Ja a vicious circle 663
Justin: Tell me a little bit how you thought or you think that you made home life hell in what 664
ways how did you behave or act 665
James: According to the people that brought it to my attention my attitude was a major 666
component of it, id come home grumpy in a bad mood I would be very short shout a lot for 667
something small and insignificant and ummm just like vent my anger on everyone and anyone, 668
for example, take a stupid example, and my mom says to me like do you have to leave that cup 669
in the office when you going from the office to the backyard to smoke and you passing the sink, 670
you then become so uptight or id become so uptight that id slam the door shut and just go on a 671
screaming tangent like it’s my cup and it’s my office and I’m gonna go back there later and if I 672
want coffee ill go to the office and fetch it you know and just your fuse becomes very short so 673
that’s that’s a lot of how I did it and to be social id find myself being very withdrawn just coming 674
home and going to my bedroom and watching TV or going to play on my computer or something 675
not really socialising much and if I do it it’s on a very short and abrupt bases 676
Justin: So almost isolate yourself not only family I presume friends as well... 677
James: Ja very much so... 678
Justin: So and now how’s things going now? 679
James: Much better now that I’m taking happy pills [laughs]... no but you also like find that 680
there’s certain things like once you’ve spoken about it it becomes easier to deal with and you 681
you sort of put it behind you and ok yes I’m now taking chemicals to improve my mood but still 682
much to my disapproval... 683
26
Justin: Its chemicals that would have been there anyway... 684
James: Exactly... but it makes it more manageable and you realise that you letting a lot get to 685
you that actually shouldn’t like for example the mother with the cup, like now ok cool I just go 686
fetch it and put it in the sink I’m sorry kind of thing you know just keep the peace, give it up 687
whereas before it would affect you to that extent. 688
689
Justin: So was it the family that finally said listen... you really got a problem here you really got 690
to sort it out... 691
James: Ja my mom said to me something along the lines like you really not the same you used 692
to be your attitude stinks and that kind of stuff and she actually went as far as saying to me 693
certain of her friends have noticed a change in my behaviour and at that point I’d also around 694
that time 5 months ago I had seriously thought of suicide seriously and I then decided after what 695
my mom had said I had two choices one I can attempt suicide fail and have a criminal record or 696
two I con go seek help, and I went to go and seek help... 697
Justin: Good very good 698
James: So ja I take happy pills 699
Justin: Nothing wrong at all... 700
James: I don’t think there is actually, you know what people don’t need to know about it you 701
take it in the morning no one knows about it, at least I take mine in the morning and no one 702
knows about it, and therefore it doesn’t make it weak, I know a lot of people in the EMS who 703
take antidepressants and have for years and it doesn’t change my view or perception of them at 704
all, I actually think it’s very admirable of them and I think it’s even more admirable for them to 705
admit it..... 706
Justin: It’s an interesting concept on why people think that to ask for help its weak almost... but 707
too actually to ask for help you’ve got to be incredibly strong, to actually go that far to ask for 708
help if you know what I mean.... 709
27
James: No I do know what you mean... it’s like my [inaudible] of suicide people say that suicide 710
is a cowards way out I actually disagree with that statement 100% because it’s not, can you in 711
your right mind, hold a gun to your head knowing that you gonna pull the trigger and put a bullet 712
through your brain and kill yourself... so you can’t be a coward to do that, you can’t be a coward 713
to put a rope around your neck and jump off a tree... you got to be incredibly strong to do that... 714
and strong willed when I say that and ummm... you’ve got to be incredibly incredibly down and 715
depressed in order to do that 716
Justin: And considering the fact that you know what death looks like 717
James: Yes.... 718
Justin: That makes it a whole different ball game there hey 719
James: very much so... so I completely disagree with that as you say it takes a lot of guts and 720
you’ve got to be really strong to actually stand up and to say look I need help... 721
Justin: In terms of coping we’ve mentioned a couple of things, first of all we’ve mentioned 722
debriefing with the colleagues, second we’ve mentioned about looking for help and asking for 723
help when you need it, any other ways that you think you it’s important for you to cope it doesn’t 724
matter how minuscule or anything else like that, any other ways besides talking about it... 725
James: Getting a hobby... I think that’s a good way... 726
Justin: So like down time almost... 727
James: Ja you time where like there’s days where I come home from work and I just watch TV, 728
cartoons because its brainless information, it’s not even information, its brainless activities you 729
sit and watch little hand drawn things run across the screen and scream and shout, it’s all 730
futuristic and fiction to even watch a horror movie for example its its brainless, you gonna watch 731
it you know you gonna scare your pants off and at the end of the day you sit and say well that 732
had no plot what so ever you don’t need to concentrate, really cause you just shut down 733
completely so get a hobby do something brainless and just chill.. 734
Justin: What’s your hobby, do you have a hobby or is watching TV your hobby 735
28
James: No I actually don’t like watching TV... I’ve got two I build puzzles in case you haven’t 736
noticed the amount of puzzles around the house and I play piano... those are my two hobbies... 737
Justin: Excellent... well thank you... 738
James: It’s a pleasure... 739
129
Appendix 3: Copy of Informed Consent
1
Psychology Department
Description of Research
Ambulance/Paramedic work is a unique and potentially dangerous environment.
Often they are exposed to a variety of traumatic incidents i.e. critical incidents.
Research has shown that these incidents may have a potentially negative effect on
mental health as well as physical health.
The aim of the following research is to gain a clearer understanding of what
constitutes as a critical incident as well as what coping mechanisms are utilised in
reducing stress resulting from the critical incidents.
Participation in the research is voluntary and will require you to answer a number of
questions relating to your experiences within EMS field. There are no right or wrong
answers. This should take approximately 1hr to 1hr30min.
Anonymity will be assured as your name and any other identifying details will not be
recorded. The information provided will be treated as highly confidential.
2
Informed Consent
In order to participate in this research study, it is necessary that you give your
informed consent. By signing this informed consent statement you are indicating that
you understand the nature of the research study and your role in that research and
that you agree to participate in the research. Please consider the following points
before signing:
I understand that I am participating in psychological research;
I understand that my identity will not be linked with my data, and that all
information I provide will remain confidential;
I understand that I will be provided with an explanation of the research in
which I participated and be given the name and telephone number of an
individual to contact if I have questions about the research.
I understand that participation in research is not required, is voluntary, and
that, after any individual research project has begun, I may refuse to