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The human cost of emergency response

Rob Ichelson’s journey to post-traumatic stress disorder began when he responded to a mass shooting near Toronto’s Eaton Centre on Boxing Day in 2005. When the paramedic arrived, information was scarce.


June 5, 2017
By Linda Johnson

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“They thought people may be shooting from the roofs. There had been threats of terrorism,” he says. “You can imagine the terror of being there and not knowing what was happening, if more shots are coming, still smelling gun smoke in the air, having police with their guns drawn and knowing multiple people had been hit by bullets.”

In the months after the shooting, which left a 15-year- old girl dead and six bystanders wounded, Ichelson often relived the event, and the fear. He began drinking. In January 2006 he was hospitalized for assessment and taken off work.

“I knew something was happening. But I didn’t know what. I knew I needed help. But I didn’t know what help,” he says.

Two years later, a colleague committed suicide. And in 2011, Ichelson was a lead medic responding to a fatal shooting at the Toronto arts event Nuit Blanche. He received some professional help, but it was inadequate. At times he contemplated suicide. Management, he feels, adopted a belittling attitude towards him and provided minimal support.

Ichelson, a paramedic for 17 years, has been working with Vince Savoia, executive director of the Tema Conter Memorial Trust, which seeks to raise awareness of the stressors faced by public safety personnel and reduce the stigma of PTSD. In October the King City, Ont.-based trust, together with the Ontario Psychological Association and Public Services Health and Safety Association, launched a campaign “You Are Not Alone” following news that some 25 first responders had committed suicide between April 29 and Oct. 1, 2014.

Savoia says he hopes the campaign will get the word out to firrst responders that there are resources they can access. There is today, he says, greater recognition that PTSD affects not just military service personnel but also emergency service personnel.

“The scenes they come across can be horrendous,” he says. “We’re just regular people, and some of the incidents we attend — homicides, suicides, mass casualties — what we see people do to each other makes no sense whatsoever and can cause us to question our beliefs. That’s when we start to question whether we can continue to do what we do.”

Dr. Megan McElheran, clinical psychologist and co-owner of WGM Psychology and Associates in Calgary, Alta., says PTSD presents a range of symptoms. One common sign is “re-experiencing” intrusive memories of traumatic experiences,  flashbacks and nightmares.

“The person will also start to avoid thinking about what happened, feeling the feelings associated with what happened, and start to get separated from his or her experience as a means of psychologically and behaviourally coping with what’s happened,” she says.

People diagnosed with PTSD, McElheran says, also start seeing the world as much more dangerous and malevolent than it was before they were traumatized. They see themselves as incompetent. There is also a sense of detachment from people around them.

Another common effect is mood changes. “They may not be clinically depressed. But at the same time, they tend to be less enthused, less interested, less motivated towards their life,” she says.

McElheran, who estimates PTSD patients make up 85 per cent of her practice, says the disorder affects day-to-day life. The person may not be able to go to work and may become housebound. They believe: “If I go out into the world, I may be hurt again” or “I’m not going to be able to handle things.

Chris Hood, executive director of the Paramedic Association of New Brunswick and president of the Paramedic Association of Canada, says the rise in numbers of paramedics diagnosed with mental health problems is partly due to an increase in the number of calls they answer.

“It’s the stresses of life, stresses of  financial issues, coupled with the increased number of calls they’re doing and decreased amount of decompression time that is causing more incidents of PTSD,” he says.

While resources vary widely across the country, Hood says, they are generally not nearly enough. The profession needs to come together to identify strategies they can use to help prevent and lessen mental health problems.

“That may mean adding resources, so the amount of downtime that paramedics have is sufficient. We also need to look at access to quicker, more thorough treatment for people with mental health issues.”

Ichelson would like to see the creation of independent, provincially funded and mandated teams trained in peer support counselling, who would reach out to first responders every time a critical incident occurs.

“We would never treat somebody with a heart attack the way we treat people with mental health illness as a result of the job they do,” he says. “We’re people, not robots, and we have to do better.”

*Originally published in Emergency Management Canada Spring 2015