All the participants addressed the importance of coping mechanisms and the skills needed to cope with a mass casualty situation, even if they had never been exposed to one.
James implies that certain personalities are attracted to the paramedic role and that as individuals, you are required to have coping
mechanisms to deal with the emotional exposure that the job involves. He suggests a ‘chicken and egg’ approach to this, debating whether you learn to cope with what you are exposed to or whether you have those inbuilt skills and they attract you to the role:
“and part of that is, are you in the profession because you can cope and are you the type of person that can cope with it or have you got that personality because of what you have been exposed to? It is probably a little bit of both. There are not many jobs that have bothered me in terms of sleepless nights”. James, L407 – 413.
The image of not having sleepless nights suggests that James has a protective box around him, and he does not allow his work to penetrate through into his private world. This may be a form of innate resilience, indicating a coping capacity that may not be present in his colleagues. The potential long-term impact of drawing on personal resilience is discussed in chapter 10.
Using humour as a coping mechanism is a common theme in all transcripts. Jessica notes that there are certain characteristics, for exampleusing dark humour in relation to her role and the cases that she encounters, that non-paramedics would not understand:
“I don’t always think it is relatively easy for friends or family to understand unless they are in the service, they just don’t get it or they don’t have your sense of really sick, dark humour that your colleagues have [laughs] so you have to laugh sometimes…. things like your dark sense of humour as a paramedic can get you into trouble with normal, everyday people with some of the comments”.
Jessica, L587 – 594.
James reiterates Jessica’s suggestion of a divide between health-care workers and the general public and other professionals, and also suggests the use of humour as a way of coping with the role, perhaps as a form of emotional detachment.
“{sieve and sort triage}… it’s a human nature thing. Unless you get robots to do it, some people do it better than others and my wife thinks I’ve got no emotion at all [laughs]… Is it a coping mechanism for me being in the ambulance service or is it the reason that I’m in the ambulance service? [laughs] I would suggest that it is probably a little bit of both. I’m not particularly sympathetic unless some-one warrants my sympathy”. James, L393 – 403.
He proposes that an issue that justifies sympathy from a paramedic is probably very different to what earns sympathy from a layperson, possibly due to the constant severity of injures that these paramedics see, alongside the inappropriate calls that they are called out to. James suggests that he is seen as having no emotion and having a hardened
personality, when in fact it appears that he separates emotion from his role as a self-protective mechanism. This may occur as a purposeful or a natural coping mechanism and it is unclear if this is from years of
working in this environment or if this is a characteristic that he had going into the service.
Considering that these paramedics have not been exposed to a mass casualty incident to date, it can be presumed that their detailed coping experience is from their day to day clinical work, their perceptions of how they may cope with such an event and also a reflection on how colleagues coped with such an event.
There is an element of anticipation that these paramedics appear to experience, and the description that Harry details appears to be from a horror film. Harry acknowledges that he has never attended a mass casualty incident and this over anticipatory response could be a
mechanism to psychologically protect him-self from what he may see if such an event does occur, with the projected anticipation being worse than the reality.
{do you feel prepared}… “as prepared as you ever could be for some- thing like that, what could be potentially a thousand people injured, screaming, blood every-where, bits of bodies everywhere, it would be just like a war zone. So as prepared as you could be for some-thing like that”. Harry, L312 – 316.
Emerging within this theme is the concept of how these individuals cope with the situations that they are exposed to in their job as front- line emergency professionals. It is evident that coping mechanisms are important, however it is unclear if these are purposefully developed or innate in the individual. The response appears necessary, individualistic in nature and dependent on their past experience, such as previous work in the army.