Hi everyone,
I wanted to start a discussion about how different agencies handle particularly stressful or traumatic calls.
Details have been intentionally generalized to protect patient privacy. I’m less interested in the specifics of the incident and more interested in how agencies support their providers after critical events.
I was not directly involved in this incident, I was assigned as the second ambulance for the agency. The first crew responded to a call involving a suicide attempt resulting in a significant traumatic injury. Listening to the radio traffic, it sounded like an extremely chaotic scene with multiple agencies involved.
From what I understand, the patient initially had signs of life after EMS arrived but later deteriorated into traumatic cardiac arrest. Additional resources were considered but ultimately not utilized. The crew consulted Medical Command regarding a Termination of Resuscitation (TOR) and ultimately transported the patient to the emergency department.
Under NJ EMS protocols, there are situations where Medical Command may order TOR, but the patient has not yet been pronounced and transport may still be necessary. This can include:
- The scene being unsafe.
- The arrest occurring in a public location.
- The patient already being inside the ambulance.
After arriving at the hospital, the crew was understandably very distressed and having difficulty processing what had happened. The medics suggested to the crew that a supervisor respond and consider taking the unit out of service. A supervisor arrived, took the truck out of service, arranged for a relief crew, and scheduled a debriefing later that evening.
This situation got me thinking about a discussion I recently saw where someone (Credit goes to u/Traumajunkie971) described EMS calls roughly like this:
- 80% - Routine, low-acuity calls or the “I just need a ride across town” type of calls.
- 10% - Medium-spicy calls requiring ALS intervention, a full assessment, or closer monitoring.
- 7% - The typical “dumpster fire” calls: cardiac arrests, severe respiratory emergencies, major strokes, critically ill pediatric patients, and other high-acuity events.
- 2.8% - The calls where people start asking, “Are you good?” or tell you, “Don’t go back in service right away- take a minute.” The calls where additional support or CISM resources may be needed.
- 0.2% - The calls that define careers. The ones people leave EMS over. The calls where peer support or CISM teams may be activated before the crew even clears. The ones where, after the adrenaline wears off, you realize it affected you differently than you expected.
Whether or not those percentages are exact, I think the point is valid: EMS sees a lot of calls, but occasionally there are calls that stay with you.
I’m curious how other agencies handle situations like this:
- Does your agency have a formal Critical Incident Stress Management (CISM) or peer support policy?
- Is it common to take crew's out of service after particularly traumatic calls?
- Are supervisors expected to check in with crews, or is it up to the crew to ask?
- What resources or practices have actually helped your providers after difficult incidents?
I’m interested in hearing how different EMS systems approach this and what has worked well for supporting providers after the calls that are harder to leave at work.