The Paramedic Podcast: Season 1, Episode 2

So welcome everybody to the second paramedic podcast. I'm your host Marissa Rose and if you've just joined us for the first time I am a paramedic in Australia. I've developed this podcast to connect paramedics to discuss important topics and for the next few episodes we'll be discussing paramedic mental health. I just want to say thank you to everybody who has reached out to me after the first podcast. I've had such a warm reception. When I've been at work I've had paramedics approach me and tell me how meaningful it was to them. I've had inboxes on my Instagram from people thanking me for just talking about it and bringing it all to light and that's allowed people to start talking here at mental health which is the whole reason that I started this podcast. So that's fantastic. Today we're going to be talking about post-traumatic stress disorder but more importantly I want to focus on post-traumatic growth and my guest today is Todd and he's just informed me that it's actually World Mental Health Day on Sunday and Queensland Mental Health Week next week. So this is great timing. Firstly just before we start anything that I or my guest discuss on this podcast are our own personal views and are not a reflection of or in collaboration with the organization in which we work. This is just a forum to educate support and connect people with interests in the topics that we discuss. So today my guest is Todd. Is it we are? Is that how we? We're. We're. Yeah. But you can call me either. Okay. So Todd is actually the director of priority one within the organization that I work. So we touched on priority one in my last podcast but essentially this is a service provided to paramedics to help manage their mental health with peer support offices and counsellors. So Todd and I connected it was at last year I think when I reached out to you and I was going to do a little bit of fundraising and raise a little bit of awareness for PTSD. And that's when we actually started talking about post-traumatic growth and I had no idea what it was at that time. So just an intro to Todd. He's had a career in emergency services for over 25 years. He actually started as an auxiliary firefighter while he studied psychology and during his time with the fire he worked with paramedics and realized how awesome we were and he jumped fence over to us. This grew Todd's passion in psychology and understanding the importance of the impact of working within the trauma context and its effect on us. After seeing the effect mental health was having on us as a consequence of the environment in which we operate. During this journey to paramedic mental health enlightenment as I like to call it. Todd acted as a staff counsellor, a peer support officer and completed his masters in counselling. Todd, you're still a registered paramedic, I understand? Yeah, still registered but not practicing, probably good for the patients. And you're also a registered psychotherapist as well, isn't it? Todd also amazingly was recognised on the Queen's birthday on his list in 2016 and you received the National Ambulance Service Medal for your work in supporting ambulance personnel and their families. So that's amazing. Testament to you and what you do for us. So just say a lot of our listeners and let me know if there's anything that I've missed out. No worries, thank you. And thank you for having me on today and I got to listen to the last podcast with Ricky and really enjoyed it. It's put a bit of pressure on me because now I've got to meet up to those high requirements, but hopefully this can be helpful as well. So I'm really happy to be on and it is really timely given that it is well done to help down Sunday and a good opportunity to think about that in the context of taking the time out to look after ourselves. Yeah, so that's not really, didn't know, that's that's fantastic, great timing. So before we really delve into things, I wanted to mention that this podcast is unedited guys. So it's going to be raw real and maybe a little bit confronting with this one. So just make sure you're listening to it in a safe place. So basically, Todd, when I first started, I think my first year starting this job definitely fundamentally changed me as a human being. It changed everything about me to my core just with, I was so naive when I started and so naive in fact that I can recall a job that I went to up north when I was posted up north and I thought the patient had had too much coffee and my partner was like, no, Marissa, he's on meth. That's ice and I was like, oh, okay, that was very interesting and I've obviously now quite good at identifying that but that's pretty much how naive I was. But so out my time, I think as I've developed as a paramedic, I found it quite easy to disconnect because what Ricky and I touched on last time was when we start this job and we walk into scenes and stuff like that. We've got this cape on right and we've got this mask on and we need to connect, the disconnect from the situation in order to cope because if we become personally invested in every scene that we go to that's quite traumatic. We'll just be a blubbering mess in the corner. So we sort of need to step up in, you know, we walk into this person the worst nightmare and they look to us for strength and we have to sort of compose ourselves and systematically work through whatever it is that we're presented with, you know, and really not, I guess, personally invest in the situation and the emotions that we expose to. And I think another thing that I've found is it really hardens you this job a little bit and you can struggle, like I definitely struggle to sleep sometimes, particularly if I fall asleep and then I wake up and then I can't get back to sleep because when you're on a night shift and you fall asleep in the car or whatever, you have to wake up and then you just got to be on for that job. So I think in your personal life, when you're falling asleep and you wake up, it can be quite difficult to get back to sleep. Yeah, it's hard to unwind. Sometimes we can get a little bit easy to anger, we can be triggered, hyper-vigilant in just in any situation or if we hear like a text tone that's the same as the text tone at work and we're out, it's can be quite triggering and you get that, why I definitely get that little bit of a little feeling in my within myself. And, you know, driving, even driving around in the areas in which we work, you tend to avoid streets or places that you've been because there's been a traumatic job there and you don't want to even driving here. I had to avoid, I avoid part of the goal because I went to quite a significant jumper with a bad outcome and I can't drive past that spot anymore at all. And I think with our role as paramedics, we never know and I think this is something we talk about quite a bit, no paramedic knows when their last job is going to be and you're only one job away from that last job. And that can be, I guess, a little bit emotionally draining for us and I think sometimes when I was talking to Ricky last time, when our cup is quite full, we find it difficult to identify that and manages, it's often the people around us that sort of point out to us that, hey, you know, I think there's something going on with you, you're kind of changing a little bit like that. So these are all things I've personally dealt with and I'm sure you did too when your time is a paramedic but for the context of the podcast, could you just explain to our listeners what PTSD is like what post-traumatic stress disorder is? Yeah, I think, and if I come back, can come back to that a little bit as well and you talking about your story and how that first year fundamentally changed you, I mean, I think I experienced the same thing, I know I experienced the same thing and, you know, there's some people in the job that just seem to get all the really big, bad jobs. Yeah, that was me when I first started in ambulance as well and there was no doubt that what I experienced even on my very first day, I can remember that job very clearly the first job that I went to changed me in a fundamental way. And that's what working within a trauma context does because it's not normal for most people to be exposed to that type of context and repeatedly. So I think what paramedics do is pretty extraordinary and it does change who you are. It doesn't always mean that it's going to mean that you have PTSD or that you're going to get PTSD and I think there's something very different about paramedics in the fact that they decide they're going to become paramedics in the first place because it's the kind of job that most people go, "I'd never do that job," you know, and they wouldn't even consider it. They wouldn't even consider studying it and I'm sure you, you know, for the amount of time somebody said that to you would be, you know, a huge amount of time. But I couldn't imagine doing anything else, so this is me, you know. So there's something different I think about people who self-select into this occupation and whether it's based on their previous experiences, whether it's based on their history or even just their sense of self-ingoing. Yeah, I might go into a job that's going to deal with loss and grief, that's going to deal with trauma, that's going to deal with human suffering, but I reckon I can do it. Whereas most people couldn't even contemplate it, so there is something different self-selecting into it. Then there's the aspect of the training that you have as a paramedic and as a very high level of skills. So you train in those skills. So there's a great deal of competency that you have in being able to deal with situations that most people would go, yep, that would be way out of my control. So I think that sense of competency, sense of control are really important factors. And I do think, yes, what paramedics often need to do is compartmentalize. So definitely, you know, I have to have a part of me switched off in order to be able to deal with this and maintain my composure and be able to treat the patient in the way that I need to treat the patient. Because if I let the emotions get to me, I can't then provide, you know, what I need to provide for that patient. So I think paramedics can get really good at compartmentalizing it. I think sometimes paramedics can get too good at compartmentalizing it. And then they're not able to touch base with those emotions later on. And also I think there's an element where you need to maintain some connection to your emotions in order to provide patient care in order to be able to provide what that patient needs when they're really distressed as well. So you need to be able to connect to that to a certain extent, but still maintain, you know, your composure. And then I think it is that element afterwards where it's really important to come back to that emotion to recognize what's happened for you in that context. Because it is hard. Yeah. I think in a way a lot of times paramedics do it naturally even when they don't know they're doing it. Okay. And I think especially if there's two people in a vehicle, I think it's harder for a single officer paramedics. But I think if there's two people in the vehicle, that general banter that you have the black humor that you have. And that general conversation, sometimes it's about that job, sometimes it's not. But I think that brings us back to the emotion and it brings us back to a human connection. So I think that tends to happen a lot of the time pretty naturally. Yeah. And I think that's really the critical component of, of, you know, peers connecting to each other. So I think connections are really important component of how we touch base with that. It doesn't mean that we have to really go into the emotion of it. And oftentimes we may not be in a position to really want to do that or unpack that at that time. But it's just that reconnection with some human connection, reconnection with some emotions. And then later on, and I think it's really important that it's when you feel comfortable about talking about it. Yeah. That's a big one because I find sometimes like priority one, they do reach out to me. Like just last week, I was a soldier by a patient. And it wasn't anything majorly significant. I just had a couple of bruises on my arms. And priority one, they did reach out to me, but I wasn't ready to talk about it. So I didn't pick up the phone. Yeah. Yeah. And that's really important because nobody wants to be forced into talking about it when they're not ready. So that readiness has to be about what when you're ready. Yeah. And you know that better than anybody else. Yeah. So I've gone on a bit of a track there, but coming back to the PTSD aspect. So I think a lot of paramedics that I talk to always worry about, oh, do I have some PTSD or I must have a bit of PTSD because of things that I've gone to. That's not always the case. In fact, it's more rare than what people think. And I think we spoke about maybe not a PTSD diagnosis, but like more symptoms and how so could you give like a defined definition of PTSD and then maybe talk about some symptoms that we may have that doesn't necessarily translate into a diagnosis. Yeah. Well, in order to be diagnosed with PTSD in Australia, we'll use the DSM5, which is the diagnostic and statistical manual of mental disorders, which is quite a mouthful. But and so that you have to actually be diagnosed with a clinician to be able to go through that criteria. And there's quite a lot of criteria to go through in terms of the symptoms that you're experiencing and the impact that it has on your life. So it's got to have a really massive impact on your life, both at work and outside of work. And if I think back to that very first job that I did that I said, I still remember very clearly and because I have done this as a bit of an exercise, I've gone back and I've gone back to the DSM criteria and I've ticked every single criteria except for the last one. This was on my first job very first day on road and the job was particularly confronting. And so if I think about that, I think, well, like my very first job on road, could I have got PTSD? But the criteria are actually normal reactions that we have in relation to a job that's really going to rental our cage. And the thing that I didn't tick in that criteria, well, there was probably a couple of things. One of them was it caused some distress in my life and it impacted on my life, but only for a short period of time. So it lasted a few days in that in terms of being really distressed about the job, but it didn't continue on for greater than a month. So and it has to continue for greater than a month where it causes, you know, a high level of distress in order to make the diagnostic criteria. So those symptoms that I had that fit the criteria are actually normal reactions. It's what our brain is designed to do when we're exposed to something that's particularly confronting. And so the criteria is quite comprehensive that a clinician has to go through in order to determine PTSD, but there's things like roominations, hyperhousel, difficulty sleeping. But they have to be related to the job and they have to cover multiple aspects of life. And I don't think there'd be too many paramedics that haven't experienced those symptoms at some point. That's what I find interesting. Like most of us can, well, I put you saying all that stuff is almost exactly what I was talking about before, but I guess the differential is so it needs to be ongoing. All those symptoms consistently over X amount of time. Like is there a set timeline? Yeah, it's a bit of a tree, but the way that it was set and it was set by a group of clinicians in America who have gone, okay, one month, if you're experiencing those consistently and continuously and impacting on all of the aspects of your life for greater than a month, then that would meet the criteria. So that doesn't mean that you would have one job and then be rattled by that for a week and have another job and be rattled by that for a week and have another job. It means it's usually related to an incident or group of incidents. So there is a cumulative PTSD, which we can talk about as well. I think for us it must be cumulative because I don't think it's necessarily one massive job, although they can be quite upsetting and confronting and really quite challenging. But like I was saying before, it's the death from a thousand cuts. It's just this and this and that cumulative effect. And it's also the human factor, I think, where you go into this job and you're working on this 80 year old guy on the ground and you look up and you see all the photos of his family and his wedding day and his wife there and she's crying and she's wailing and you know in 10 minutes, you're going to have to know that he's not going to be viable. You're going to have to break that news to her. And like that's devastating, that humanity factor and I guess it's not ever just one job. It's always a myriad of jobs. That's going to cause us to have these like constant, I guess, reminders of those feelings. Yeah, I think you hit on a really good point there because we do know that it's often not the big tea trauma that really rattles your cage. It's often something that has an emotional connection or a personal connection. Definitely. That's what gets at me. Yeah, absolutely. And that tends to be what the biggest issue is. I mean, paramedics can go to huge jobs that are that are other people would think would be hugely traumatic. And but if it was all under control, there wasn't too much emotional connection, they're often okay. Yeah. But if there is that personal connection or emotional connection, that's when it becomes challenging. And if I can, if I think back to my first job that I went to, the patient had died and we couldn't do anything more. So clinically, really, it was an easy job. But it was the family that we were then having to deal with. Yes. And then thinking about how that family was going to be suffering over, you know, however many years following that. So and it was that emotional connection that was confronting to me more than the actual job itself. It's a real connection to the reality of what's occurred. That's right. And you can't disconnect. Yeah, you can't disconnect. So when there's jobs and say things like that, things like when we're assaulted in the course of the job, that's a personal impact to you. So it's hard to stay away from the tired compartmentalised from that. So they're the types of things that we do know tend to rattle your cage more. But that again doesn't mean that you've got PTSD necessarily. So there is certainly, I think there are people who will have PTSD that don't really know it. but often you can see. see that because they're really struggling across a whole heap of areas in their life. - So let's go into that a little bit more, 'cause that's a little leads into what I was next gonna talk about is, and Ricky and I touched on this, but from a psychotherapist point of view and someone with all your experience, what are some signs that a paramedic might be suffering from the symptoms? So just to find some symptoms that would concern you as a professional. So I think if somebody is feeling angry all the time, if they're having difficulty sleeping, if they're ruminating about the job continuously or about an aspect of the job continuously, if they are unable to, you know, do it or work, some people are at the point where they can't put that shirt back on and get to work. So there's so much avoidance there that they just can't manage to get back there. - Yeah. - So, but again, all of those things are kind of normal at times after a job and it's how long it lasts, that is the main factor. - So it's mainly that time frame, that time frame. - See, that worries me a little bit because I feel like when we're, especially with the workload on the goal course, when we're constantly bombarded with like, 'cause one person can have one traumatic event, but we are experiencing several a day, sometimes maybe, you just don't know what you're going to. And I guess you could argue that that is continuous and over a timeline because you never get the chance for it to stop, but is that different again or because of the nature of the compacting? Or does that make sense? - Yeah, yeah, it can be. And that accumulative trauma is certainly an aspect that can lead to PTSD, but it's not a certain outcome. And the thing is, is what happens in between those things? So we know that what will increase the risk of PTSD is not sleeping well. So making sure you have good sleep, which is a real challenge at shift work. - That's very challenging, especially with the night shift here, you don't stop and you don't finish on time. - Yeah, absolutely. I would, when I was on road, would really prioritize sleeping during the day, even though it's difficult. But it is really important when we think about the neuroscience around what's happening with the brain in the context of trauma. - So touch on that a little bit, how does sleeping, 'cause I know that there was a really interesting book, someone recommended, I think it was like, why we sleep or something. And so talk about how we process trauma, I guess while we sleep and why it is so important, because I know sometimes I just cannot sleep during the day and I also don't like taking sleeping tablets because that's a very slippery slope for Amboes, but I struggle to sleep during the day. So yeah, just tell us how important and why sleep is so important. - Okay, so can I come back to the neuroscience? - Totally. - Because I love this stuff, because it's really interesting and it provides some, modeling for me around what's happening for people physiologically when this occurs. So if we experience something that's particularly traumatic, particularly disturbing to us, then we are gonna have a part in the brain called the amygdala, it's going to activate. So the amygdala is deep down in the center of the brain or towards the brain stem, so it's part of the autonomic nervous system. Now, in the context of trauma, because it does other things in other contexts as well, but in the context of trauma, the amygdala wants to go am I in danger? Yes or no, that's pretty much it. And that's gonna be based on stored emotional memory. So that will begin when we're very little and might talk to a stranger and your parent might say, I don't talk to strangers, it's dangerous. Okay, that'll get stored away in the amygdala. Or I might touch a hot plate and burn my hand, pull it away, okay, that's now dangerous. That'll get stored in the stored away in the amygdala for really fast access, because that happens in a fraction of a second to access that memory, basically. And so I often think of PTSD really is a problem with memory. So it'll get stored away in the amygdala for quick access in the future. We also think that some of the emerging research around genetics and epigenetics is that we're probably born with information as well. That will activate that amygdala really quickly to keep us safe. So the next part is, if that gets activated, so you can visualize it on an F-R-M-I and-- - What's an F-R-L-I? - Sorry, functional resonance imaging. - So like a little look into the brain. - Yeah, you can use an imaging machine to look at the brain. And this is why it's really exciting, because only the last 10 years we've had the technology to be able to really see what's happening in the context of trauma. - Yeah, okay. - So if we have a look at that, you can see that the amygdala's got a resting potential, it's a bit similar to cardiac muscle, it just doesn't contract. - Okay, yeah. - And when it's triggered, you'll see an increase in electrical activity in that amygdala. So it increases that resting potential, it'll trigger your hypothalamus and that will release adrenaline or adrenaline. - With that stress response. - Yeah, that's just stress response. So, and as you know, that's a normal response. You know, even if somebody scares you when you're walking around the corner, you'll have that stress response. And that leads to fight, fight, or freeze. So, at the same time, there's a part in the brain that sits behind the amygdala, called the hippocampus, and its job is to record the narrative of the event. So, it wants to record the beginning, the middle, and the end. And hopefully, it will record the end and go, "Okay, this is now over." And that there's no, I'm now safe. So we can down-regulate all of this hyper-rouseball from occurring. Concurrently, the blood shifts away from the pre-frontal cortex, which is your thinking logical reasoning part of the brain and shunts it back towards the limbic system around this amygdala around the hippocampus because your brain's going, "We don't want you thinking about stuff. "We just want you to go into survival mode "into that fight, float, or freeze." So that's why sometimes when you go to a job that gets really overwhelming and you think, "Oh, my brain has gone blank. "I can't think of what I need to do next." That certainly happens for me when I'm doing exams. I look at the paper and I can't understand the words on the page. And if I could do a scan of my brain at the time, it's probably prioritizing my limbic system. The blood flow would be there and I'll have a decreased blood flow to my pre-frontal cortex at thinking logical reasoning. So now, this is a long way of getting around to the sleep aspect too. - That's very interesting, though, you're going, yeah. - So the hippocampus, in most instances, that will reach the end of the narrative. And if we think about when we're driving along in a car and we slam on the brakes because somebody slams on their brakes in front of us and we just miss them, the hippocampus will go, within a fraction of a second, you'll activate, you'll go, "Yeah, there's the beginning, there's the middle." And it's now over with, we'll normally take a deep breath, we'll still feel that hyper-rounds will occurring for a bit, but our brain will start to go back to normal and go, "Okay, this is okay." Now, the problem, or the difficulty with the context of the work that you do as a paramedic, is that it's not easy to create the end of that narrative at times, which is why those emotional types of jobs or those ones that have a personal connection is going to keep that part of the brain activated, that limbic system activated. - That makes sense, yeah. - Because your hippocampus is going, "Oh, this is not over yet, I could still be in danger or I could somebody close to me, could still be in danger." - Okay. - So your brain's always going to err on the side of safety for you to keep you alive or those close to you alive. So it'll keep that process activated, it'll keep the hippocampus from closing off the narrative. - Yeah. - Now, the other things that can make that occur even more so is when we are exposed to something again, straight away, that might be confronting to us, so that could be another trauma, or it could be somebody yelling at us for something, you know, could be getting home and having an argument. So there's a whole heap of things that might keep that process going. One thing the hippocampus is not good at doing is separating those separate events, and it will just throw it in there. I often think, I say to people, it's like cutting up pieces of string, chucking it into a box and it gets tangled. So the more that it gets tangled, the harder it is to untangle. So that's what can then occur for the symptoms of fight flight of freeze, which is basically what PTSD is, from continuing on for longer, than just that short period of time. And it's not always a logical process, because sometimes you go to a job and you think, "Why am I so hyper-aroused around this? Why am I feeling like this?" - Yeah, totally. - But there's something about it then has a personal connection, and I often think, like I drive down the Bruce Highway every morning and get stuck in traffic every morning. And so often I notice, "Oh, I'm having a hyper-arousal response. I'm having that sympathetic nervous system response where I'm feeling my heart rate increase. I'm feeling my rest rate increase." And then I'm thinking, "Why? I'm not going to die." Like I'm safe, I'm in traffic. There's nothing that's going to cause danger to me. There's not going to be anybody at work looking at their watch going, "Oh, you're five minutes late or 10 minutes late." And very rarely am I late. So there's not a logical thought process that I'm going to be in danger, but there's something there in my amygdala that's stored away that says, you need to get there on time. So, after. So after some therapy, I think what that's about is actually trying to log on to a vehicle on time when you're describing that I'm like, "If I, because we have to get to work for everyone who isn't an embo, we have to get to work early to check the car, to check the drugs, to make sure that we're prepared absolutely anything that we could be confronted with, and if we're not there early, you're late, and then that's someone's life, like that's really quite stressful." That's right, and one of my very early jobs was we didn't have time to check the vehicle and we got to the patient, we didn't have the equipment we needed, and that was terribly distressing. Absolutely. So, I think that also is part of what's then stored away in my amygdala, you need to get there early, you need to be able to be organized in order to keep somebody safe, and so logically I know nobody's in danger, but emotionally my brain's going, "Yeah, somebody could be at danger." So, then if I come back to, then, so, lots of those other stressors in your life might keep the hippocampus tangled up, and so oftentimes when people have got financial difficulties, relationship difficulties, we can be more susceptible to having stress reactions like this because, again, it's those pieces of string that are cut up and put into the hippocamp as. So, one of our brain needs to do is somehow close off that narrative and send it off to longer-term memory, which we know is scattered around the brain. And that happens by a few different ways to help that. Part of that is having some downtime after a job that really battles our cage, and oh, I know, and that's a hard part, isn't it? It's so hard with work, though. It is. But, yeah, sometimes it's just not viable. Yeah. And it doesn't always have to be a lot of downtime. Sometimes it does need to be-- Five minutes. Yeah, five minutes. What a nice song on. Yeah, put something on. Have a coffee, something. Have a coffee. Yeah. Even sometimes it's just making up the car and having just that time to breathe, having a bit of a joke to your colleagues. Yeah. Those types of things will, again, increase that connection, increase oxytocin, reduce that hyper-rounsel from occurring, and are really important components. The other important component is having the opportunity to talk about it in a safe context. And that's what we were talking about before. You don't want to be pushed into talking about it when you're not ready to talk about it. And I'm very stubborn. Yeah. So if I'm pushed, it's not a good time. Well, we know if then somebody tries to push you, all it's going to do is activate that limbic system again. Yeah, totally. You're a bit anxious. And then it's like, well, I don't want to talk about it. Should I be talking about it? Yeah, that's right. Yeah. And again, that's another piece of string that then gets cut off and put into that box. Oh, yeah. So it's got to be at a time when you're ready to talk about it. Definitely. But when you can talk about it, then it enables to pull that narrative together. Now, we're meaning making machines. We need to have that narrative. It pulls that narrative together and it helps us close it off so that it then can go to longer-term memory. So then the other aspect is sleep. And this is still a bit theoretical. But what we can see is that when we're sleeping, we can see a discharge from the hippocampus occurring, which scientists believe that is basically memory going to longer-term memory. So that short-term memory of being in danger, then going to longer-term memory. So you can actually see that discharge from the hippocampus when we're in REM sleep. And you mentioned sleeping tablets before. The irony with sleeping tablets, when you can't sleep, you take sleeping tablets. But then you don't get a REM sleep pan. So then you don't actually get that discharge of the hippocampus either. So when it goes from short-term memory to long-term memory, what benefit does that have to us? So then it's now no longer active in that limbic system. So once it's sitting there, everything is going to trigger that. So it's that short circuit, and then it goes into like a further back place, where it's not really accessible in those times of stress, is that right? Well, it still maintains being accessible. And I think this is one of the tricky things around trauma, is that if I think back to that first job, and that was over 20 years ago, I can remember it's super clearly. Yeah. But I don't feel like as if I'm there. And that is one of the fundamental differences with PTSD. Is that there's stuff that you're going to remember that you can't unremember because they're experiences that are confronting, that go against your values, that have a personal connection. So you're going to remember those, and you can't unremember, in fact, our best way of learning is through experience. So our brain will actually learn that even more. But when we have PTSD, then it feels like we're actually back in that moment. We might smell the smells that were there, we might hear the sounds that were there. And it feels like we've actually gone in a time machine and a sitting back there then. And that's a bit different to remembering. That job down the road, that jumper, I feel, that's why I can't drive by there. Yeah. Because I have all those feelings when I go near it. Well, that avoidance reaction is a really normal reaction, in fact, it's your brain trying to protect itself from getting hyper-rounds. And sometimes, if we avoid it for too long, then it will just maintain those connections there. So what would you recommend paramedics do who are doing what I am doing? Well, I think the first part is noticing what you're doing because sometimes you don't notice it. Sometimes it might be okay to avoid that situation. And I think about, you know, I live in an area where I work in ambulance. So I'm often going past houses where I've, you know, people have died and, you know, there's been significant situations. Sometimes I will avoid those situations. And that's okay. Because I know that I'm not super distressed. So otherwise, the other thing then I think is helpful is sometimes just processing through some of those traumas because you don't know what stuck there. And I'll talk about processing the traumas and shortly, but being able to process those traumas, so then it's no longer stuck in that short term memory. And it can then be scattered to longer term memory. So it's not so much of a trigger? Yeah. I mean, if it's not particularly distressing, then that might be okay. But if it is distressing and it's triggering, then being able to process through that trauma is certainly really helpful. And, you know, and it also depends on, you know, because sometimes people can be so avoidant that, yeah, they can't, they can't, well, it's my best skill. Oh, I know. Avoidance is the best strategy. I'm really good at it too, except when it comes to chocolate, but that's an avoidance in itself. Oh, my chocolate. Yes. And that is often our default because it is the easiest way to handle a situation, but it's only good for a short period of time. Yes. Avoidance. It's like putting off your assignment. Initially, that feels good. But then, as it gets closer to the due date, then you start to feel that trigger. Yes. You know, occurring. Yes. So, so sleep really helps with that, you know, memory discharge into longer term memory. And the other thing that's really helpful is to have some exercise because we get adrenaline and nordrellen, which go up and peak really quickly and then drop down pretty quickly as adrenaline does. It's got a very short half-life, but cortisol stays up there. The more cortisol stays up there, the more likely it is to become hard-wired in the brain. And essentially PTSD is this activation becoming hard-wired in the brain. And there's a thing called heavy and theory that neurons fire together, wire together. So the more they're firing together, the more that's going to become solidified. So exercise helps drop down the cortisol. And you don't have to be a marathon runner, just getting your heart rate up enough. I love training. It's massive mental health benefit to me. Absolutely. It's really good. Now, the benefit of training and mental health. Even walks. Going for a walk. So good. Outside, fresh air. Yeah. That's awesome. Yeah. Beautiful. Oh, yeah, there's a couple of things around that. It can be excited around the aerosite. Yeah. So there's aspect of where it burns off cortisol, but even getting out in nature, we know helps release endorphins. And there's even some research suggesting the further distance we can see helps us feel safer and calmer because we can see if there's any risk, I think, from an evolutionary perspective. So getting out in nature really does help as well. So and this is what I mean by it depends on what's happened in between those jobs. If we're really intentional about looking after ourselves between the jobs, then there's much less likelihood that you'll end up with PTSD. Okay. That doesn't mean that you're not because there's other factors and it's quite complicated genetically as well. But it much more reduces your chance of PTSD. Okay. So just to link it back and we're going to start transferring into post-traumatic growth, I feel like we need to have another episode with you because there's so much that we can talk about and it's so exciting just to listen to you. But yeah, I just I really want us to talk about just quickly as well just before we do that. And I think this is a question that a lot of paramedics are curious to ask but a bit nervous to ask and a bit nervous to know the answer to. So if you do have a full morning. diagnosis of PTSD as a paramedic. Does that make us unfit for duty? Like, are we blacklisted then? Like, what's the go with that? Because I know that maybe some people would be hesitant to reach out for help because they don't want that diagnosis because they don't want to lose their job. Yeah. Yeah, that's a really good question and it's one that I find really important to talk to people about. So historically, yes, that was the case in most emergency services in military, that if there was a PTSD diagnosis, then that was often the end of your career. The problem was back then was that people wouldn't feel comfortable about coming forward. They would have PTSD for a very long period of time. And we also didn't have the sophistication around treatment models that we have now. So we actually do have people who have come back to work in an ambulance context in a full frontline capacity after a diagnosis of PTSD. And the critical factors are them being able to get access to treatment really early. We know one of the big factors around prevention of PTSD is early access to treatment and going through that process. And then yeah, there's no reason why people can't come back to work with PTSD. Sometimes people get to the stage where they actually they get to the point where they go, I don't want to come back. And that's that's okay as well. But you know, hopefully they're at a stage where it's not impacting on our life. And we would still continue treatment. But sometimes people are at the point where no, I don't want to be back at work. But I think a lot of the time now, if it's that early access to treatment. And even if it's not always that early, but just getting that access to treatment, the right treatment at the right time, then that's what's really helpful in the context of coming back to work. So yeah, and we've got really good evidence around treatments. There's the Phoenix guidelines, Phoenix is basically the the National Research Institute for Trauma. And their guidelines talk about CBT cognitive behavioral therapy with a marginal exposure. And EMDR, which is eye movement desensitization and reprocessing, which is a mouthful. But essentially EMDR replicates REM sleep in some ways. Interesting. So, and then there's also aspects around mindfulness to help decrease that hyper-rousele. And so they're really strongly evidence-based models. But there's also other good research. It's coming out that it's harder to evaluate because these ones are really manualized ones around, you know, I was talking to somebody in Canberra who was with returned veterans doing work with drama therapy and finding really good outcomes. What about animal therapy? Equine therapy. I'm big on equine therapy, you know about that. Yeah, there's really a, there's a lot of emerging research coming out around equine therapy because horses are a really good biometric feedback device. If your tents, the horse will feel that you tend, so you've got to be relaxed. So, there's lots of really good work coming out around equine therapy and used in conjunction with cognitive behavioral therapy or other types of therapies as well because it is so good at just being able to measure your level of hyper-rousele. And you're having that ability to control that hyper-rousele. So, yeah, absolutely. There's good research around equine therapy as well. Fantastic. And I think to what Phoenix now, their guidelines are living documented used to last four years, I think, but now they're finding that PTSD is not the same for everybody. In fact, some people have it experienced different things more symptomatically. So, the treatment needs to be different for them. Yeah, it needs to be different for each person. All right. Well, now we can just, I'm really definitely going to be back here. So, let's talk about post-traumatic growth. Yeah, this is something that you taught me about and we found ourselves on the phone for a very long time and I loved our conversation. So, the concept that PTSD is one outcome of a traumatic event where there are many others and PTG or post-traumatic growth is one. So, a study by Shakespeare Finch and others that you actually sent me shows that how traumatic events can be a catalyst for positive changes. So, I kind of want to change the outlook on PTSD from being something negative that it can be something positive. Yeah. So, it can cause changes in priorities, philosophy on life, improved relationships, gratitude, a greater understanding of the concept and transience of life, resilience and personal growth. And this is something, this was a quote from one study that was found within this study and it was a traumatic event can act as an emotional earthquake to destabilise an individual's psychological foundations and ultimately grow. I like that is powerful. So, can you talk to me a little bit about PTG? Like, I know this is something you're extremely passionate about. I am very passionate around PTG. Here's the board, go for it. Just throw something at me when I'm talking too long. But PTG, we actually know from research that more people or more paramedics are likely to experience PTG than they are PTSD. That doesn't mean that they're completely separate things. You can have PTG and PTSD at the same time, but more paramedics are likely to experience PTG. And post-traumatic growth is different to being resilient. You know, as a paramedic, the more you expose to different jobs, you become more resilient because you go, yeah, I could deal with that before so I can deal with it again. And you know, I think about the first cardiac arrest I went to pretty anxious, pretty nervous about it, but by the time I got to my 10th one, I'm feeling, oh, you've done this before. That's okay. But post-traumatic growth, so oftentimes, though, those aspects may not necessarily be traumatic. So, might be a little bit of a bother, but we know we were able to get through it. And that will increase our resilience. Post-traumatic growth is when we experience something that completely shatters our worldview and listening to you talk about your experience before in that first year of being on the world. Yeah, your worldview was shattered. Grumbled. Yeah. And so it takes an event that really shatters your view of the world. And I don't think too many people come into the job really expecting what they're going to see. You can't. No, you can't. So there's oftentimes, you know, it is a case of when that happens for people in terms of they experience something that just shatters their view of the world of how things should be. So things that, you know, against humanity, things that you experience and you think that just should not happen. So, you know, child abuse, those types of things. And the event has to completely, and did you say seismic? It has to be a seismic event that completely shatters your view of the world. So post-traumatic growth is not about, oh, I'm fine. And, you know, I'll be fine dealing with it. In fact, it's about having something that just flaws you. And then it's the struggle that we have. And as humans, we are actually naturally resilient. It's a struggle that we have in making sense of what we've just experienced that helps lead to post-traumatic growth. Those factors around, you know, the supports that you have and all of those stresses are really important in this, you know, having, you know, supportive people around you, having that opportunity to talk about it. They're things that help process through the meaning. But essentially the meaning is, you know, oftentimes then it becomes that, well, yeah, I can deal with stuff that is really big. It doesn't happen straight away. And it happens over a period of time. And, and if I think about my own experience in ambulance and exposure to trauma, as I said, I was one of those people that just got so much trauma, even on my first year on road. Yeah, that's wrong, but if I think about myself now, I can look back and I think actually, when I think about what I was like then to what I'm like now, I feel much more confident and confident in myself. I can deal with some huge stuff and I can survive it. I can get through it. If I think about, you know, life, I think about how much that's changed when I first started in the job, you're probably thinking about money, you're thinking about your career. But then when you've been in the job for longer and you've had these experiences, you start to think about, oh, maybe relationships are important. Maybe, you know, evaluating the relationships that I have, finding out what's important to me in that context and connections are more important perhaps. And it may be lesser around those other aspects that you did think were important. And it brings you into a deep state of contemplation as well. Like, I definitely contemplate the many of life after a significant job. You go to something and it's just like, man, it'll floor you and you just really go into deep contemplation, I think, as well. Oh, it's no, you put me on the spot. I think, oh, I think you just, like you go to something and it's really significant and it can have a personal effect on you. And then you just kind of think, man, what am I, what am I doing with my life? What's the meaning of my life? Yeah. How can I, I guess, why am I here? What am I meant to do? Am I doing enough? Am I happy? Yeah. What is important to me? What am I not doing enough of? Like, yeah, I get really deep. after a good job, I think, and that can also be a little bit overwhelming as well. Oh, yeah. But it's those questions that you ask yourself that can lead to post-traumatic growth, because if you're just, you know, humming along happily in life and nothing ever happens, you don't tend to ask those questions, but it takes something to happen to then to start thinking about, well, what is important to me? What is it that I need in life? And that's what leads to the post-traumatic growth aspect? Where is there is that thing? Okay, you know, some things are more important than I thought they were, and sometimes relationships break up because of it, but people are evaluating maybe this relationship wasn't healthy for me to start with. So it's that evaluation of relationships, it's about that appreciation of life. And so often when you talk to paramedics, they go, oh, yeah, I get that, you know, like I have changed over time in the context of the work that I've done. And there's an opportunity to think about new possibilities, and that's exactly those questions that you are asking yourself when you said you get down deep after something is really vital to cage. And for some people as well, there's a change in spiritual growth. So whether it's. Yeah, and it doesn't necessarily mean that it's an organised religion, it could be a sense of something greater or, you know, it could be nature, it could be an aspect of that. And so the research around post-traumatic growth now has set it's much more likely in paramedics than negative trauma symptoms. But it's also been demonstrated in refugees, people from countries who have experienced huge amounts of trauma. It's also been experienced with cancer survivors, it's also been experienced with, you know, domestic abuse, that all of those situations actually can lead to post-traumatic growth. And that sense that, yeah, I can deal with this now. And so I am really passionate about it because when I think about it, I think, yeah, I've definitely experienced post-traumatic growth. That doesn't mean it was easy, and it's a really hard road. It is hard, it's hard, it's hard, I've done too a lot in the past two years, particularly around this. And I think that's why you and I connected so much on the phone, because I could relate to so much to what you were talking about. But I think post-traumatic growth allows you to really go within yourself. And I think understanding mindfulness and I guess spirituality and learning how to be still and an appreciation and gratitude. And all these sort of really important things that, because you can get down in the dumps after a big job and beat yourself up and all these sort of stuff, or you can learn from it and go from it. And I guess like going to big jobs definitely gives you perspective. And it allows you to be grateful for the things that you do have, because we do see the, I guess the fickleness if that even is a word of life. I just know. But yeah, we see how transient life can be, and how it can just be gone, and people's worlds can shut off in a second. And I guess it gives you that perspective to, yeah, be grateful and live life in a way that's meaningful to you. Yeah, and that's part of those questions that we ask ourselves after those things. You know, people younger than me have died that I've been to. So it's those questions, well, I've got to appreciate life now while I've got it. And so it is so common for people to experience post-traumatic growth. It was first coined in America, and I was talking to a group of American EMS chiefs, and they'd never heard of the concept of PTG. He didn't even haven't heard about it at all. I'm like, I talk about it on the ramp all the time, like you guys heard about PTG? No, I was PTG. Yeah. I'm educating. I'm telling everyone about it. It's funny, because these guys are now educating their people in America as well. Because when they started to hear about it, they're going, yeah, that's exactly what I've experienced. Resonated. Yeah, it's really resonated for them. So then, you know, next time I saw them, they were actually starting to train their paramedics in America around PTG as well. But yeah, and it's been looked at across multiple cultures. And some of those domains are more prevalent in some cultures compared to others, but they're all consistent that people will experience post-traumatic growth. So interesting. It's so much evidence around them. Yeah, definitely. But yeah, we very rarely talk about it. Isn't that interesting? Why is that, I wonder? Like, honestly, since I'd never heard about that term until we started talking, and I remember that exact moment, and you were telling me exactly what we've just been talking about. And I was just like, oh my goodness, this is exactly like a blueprint to my life right now, like all of these things that I've been going through. And it's so nice to get that affirmation that this is a positive thing coming out of something that was negative. Yeah, absolutely. And it is, and I think sometimes people view it as it's just a simple thing, or it's an easy process, or it's looking through rose coloured glasses, but it's not. It's a hard, hard process. And it has to be that point where we struggle through those things and reach the point of the other side where we can make meaning of our life. And asking ourselves those questions, what's important to us. And sometimes that means it's talking to somebody external, so talking to a therapist, and that can help unpack it sometimes. Sometimes it means talking to a close friend, sometimes people can unpack it through their head in a way that they're okay, but it is about then yeah, that feeling safe, and then being able to unpack it. Being safe is big because it's difficult to be vulnerable, and to, and, and really be vulnerable and raw with, with all this stuff, because we, and paramedics, we can get, like, things get pretty dark for us. And feeling that safe place and that place of vulnerability is tough, especially when you're at that, like, the, that emotional earthquake that, that rattles you to your core. And really, it can beat you down, and you can get really deep in, in thought, but yeah, being vulnerable is okay, and allowing yourself to go as a result of that vulnerability. And, and that actually, the irony in it is that vulnerable moment that you, you experience and you exist in and you sit in, it strengthens you. Like, you would never think when you're in that spot and you're in that place of, like, despair that, that moment is what's gonna make you rise up. Yeah. Like, that's a powerful thing. Yeah, it is that vulnerability that helps strengthen you. Yeah. And it, and it takes being vulnerable, but that is a hard thing. Not, yeah. It's a very hard thing. It's a sticky feeling. I talk about vulnerability all the time, and I'm really bad at it a lot of the time. And so I don't think there's too many people that do it easily. I think paramedics feel that they have to be, you know, capable of everything and be superheroes. And, and, you know, not let things bother them, but they're humans. Our brains are the same. You know, everyone's brain is the same in your brains designed to react that way. And it's designed to react that way for a reason. And this is how we do survive. This is how, you know, allowing ourselves to be vulnerable. Sometimes we don't allow ourselves. It just happens. But that vulnerability allows others to reach out to us. It allows us to be able to reflect on what's important for us. And it helps us grow. And I think it helps us notice it in others. And then we can be that strength for other people who are vulnerable, because I think when you've experienced that and you've been there, and you look at one of your people, like one of your fellow Ambos, and you see them in that spot, it's like, man, I know I get it. Like, let's talk. Let's go for a walk. Let's figure this out together. Yeah, that's right. Yeah, it gives you that. Well, what I find really amazing is that oftentimes paramedics go, oh, I didn't think other people thought like this. And especially when they're in a group context and they're talking about, you know, what they're feeling, they think everybody else copes so well. I guess we don't like being vulnerable. We're like little sneaky things that pretend we're you know, we stick our chests out. We're all good. But yeah, when we, and that's why I started this podcast because we're opening the forum where like, this is normal. This is okay. And we're human. Yeah, absolutely. Yeah. That's what your brain's designed to do. Yeah. Awesome. Well, I think where we've got a couple more minutes, I think. So let's just, I think we already touched on animal therapy and exercise and healthy eating with coping with all this stuff. I guess just to finish it off, look, can we have a chat about compassion fatigue? So have a chat. Well, my version of compassion fatigue is basically when we struggle to show compassion for things that we don't think deserve our compassion basically because we go to so much stuff that we deem not ambulance worthy, which I'm not saying that it's not. But in our opinion, what we train for is what we should go to and often that's not the case. And we struggle to, I guess, give compassion to people with the stub toe or something like that. So can you touch on compassion fatigue a little bit for us? Yeah, I think there's a couple of aspects to it. I think there is that aspect. And I think there is that aspect where we give compassion so much to everybody that it just becomes too overwhelming for us as individuals. And I think that can be a real struggle as well. So there's the part where we go, does the person deserve. my compassion. And that is often amplified by our experiences of the really extreme cases. So, you know, I've just gone to somebody who lost their child and now I'm going to a stub toe. So, that's hard for our brain to be able to get around that aspect. And because our brain is still thinking about all of that compassion for that last job. So, then there's that aspect where, yeah, you're just giving compassion and that all you're doing is giving and giving and giving. And eventually you're running out. And in your personal life. Yeah. I find it. Yeah, when you get home, it's like, well, I live alone and I'm single, so it's good. I just go home to an empty house and I can just sit. But I can understand people with families and they go home and then they've got a, there's that expectation that they have to give that's part of themselves to their family and they're just exhausted from work. And I guess that's a compounding thing as well. Oh, it is. And it's so hard with relationships because you get home and your partner wants to talk about, oh, I don't know, what's something that's not that important. And now I'm having trouble thinking of anything. Someone didn't leave enough milk in the fridge for the moment. I went to use the milk and they can't believe that Karen did that again. And it's difficult. It's just you can't relate. Yeah, you can't relate because you're thinking, oh, you're complaining about milk. And I've just been to somebody who've lost their family, you know, or lost their family members. So, but for the person who's saying about the milk, that is a big deal for them. And they often don't then recognize that it's what you've been through because you may not talk about it. Yeah, that's right. You might not be able to even disclose that. So that can cause some real difficulties with relationships. And then there's that compassion that becomes hard to give at home. Not so much compassion for tea, but that is then that compassion that becomes really hard to give at home. And then your partner goes, oh, you know, you're never giving me, you know, what I need. So what's a tip that you can, we'll have to wrap up in a minute, but what's the, what's a few tips that you can give for paramedics in that situation, like with their partner or what's some feedback for, you know, with that? Yeah, I think it's really important. I think it's really important that partners have information around what it might be like for their partner as well, particularly if they don't work in a, you know, health context. So, and I think it's important to have that conversation where you can say to your partner, look, I just, I just can't talk about this now. I've had a really big job. And I can't really talk about the detail, but I just want you to know that I've had a really big job. And it's hard for me to engage in that. So communication, communication. Yeah. Yeah, right. It's just not always easy either. So and especially when there's a motion tied up into it. And if you've been to a big job, there's probably a motion tied up for you and there's a motion tied up for your partner. But being able to have that communication in a way that is consistent, you know, sometimes your partner might be able to hear some of the detail because they work in a health role or they work in a emergency services role. But oftentimes people go, oh, you know, I used to tell my partner that sort of stuff when I first started, but realized pretty quickly that that was too distressing for them. Yeah. So, but being able to have something that you can say, look, I've just been to some terrible jobs today. I don't think I can deal with, you know, I just need to sit here. I just need to put Netflix on or whatever. Yeah. And have that time. Yeah, communication, communication. But yeah, the self compassion stuff. But then I think you can't keep giving to people if you don't give to yourself as well. So, and I think that's one of the antidotes. That'll be a whole nother podcast. I'm going to get you back here. But we're going to have to wrap up, I think, because we're pretty much on the on the time now. But thank you so much, Todd. This has been amazing. I'm sure our listeners want you to come back. It's been very interesting. And yeah, I hope everyone's enjoyed it. So you can follow us on the paramedic podcast at the underscore paramedic podcast on Instagram. And all of our stuff is going on Spotify. So we hope you enjoyed it. And we will talk to you soon. Thanks for having me. No worries. See you later. See you.