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THE FACES OF FATIGUE

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Fatigue is a legitimate and dangerous problem affecting many paramedics and first responders today. On November 1st, 2017 I began painting 100 paramedics portraits over 100 consecutive days. I initiated this journey with the intention of creating awareness surrounding the important issue of EMS fatigue.

This project is nothing short of an artistic marathon, inducing fatigue in myself, to raise awareness about fatigue in the field of paramedicine. As soon as the project launched it quickly became evident what an impact this project could have on a global scale. Immediately I began to receive a flood of emails from paramedics and their families eager to share their stories with me as well as their gratitude for my undertaking of this momentous project. The project gained momentum rapidly with plenty of media attention, none of which gave me the freedom to fully express the motivations of the project until now. I am employed as an Advanced Care Paramedic in my hometown of Calgary, AB. Currently, I am on medical leave recovering from surgery which was the unfortunate result of a workplace injury.

Collectively the field of paramedicine has been a bitter-sweet facet of my life.

Through this profession, I have formed many close friendships which have helped to shape the person and paramedic I have become. I have had the privilege to share in the first and last moments of people’s lives. As first responders, each day we are able to share in the best and worst moments of human existence. It is in these precious moments that we have the ability to impact so many lives in either a positive or a negative way. This responsibility is not for the faint of heart. I take my responsibility very seriously which provides me with a deep appreciation for the gift of working in this field.

Conversely, I have made many sacrifices to help others in their time of need. I have missed countless special moments, important events, and holidays with my daughter, Averi. I have been injured numerous times at work both physically and mentally. In the past few years alone, I have undergone major surgery on both of my hips and most recently on my left arm and wrist. I have had several shoulder, neck, and back injuries. I have been assaulted while working serval times. I have been exposed to toxic substances and many deadly diseases. Each one of us has borne witness to the profound suffering of humanity. Exposures that affect us each in unique ways. Personally, I have responded to calls that revealed to me the darkest parts of human existence. I was diagnosed with PTSD in 2014.

At work, long shifts with no downtime became all too familiar. Consistently working overtime before and after shifts became routine. I felt no support from my leaders and braced myself each day for the state of low morale amongst my co-workers. A series of injuries initiated a positive feedback loop of pain, which became my new state of normal. The cycle usually went like this: sustain an injury of some type during my work week, suffer during my days off, begin to feel slightly better, and then once again return to work.

We now know from neuroscience that our brain registers and responds to both physical and emotional pain in nearly identical ways. Thus, it didn’t matter if this week’s injury was mental or physical, either way, I found myself suffering on a regular basis. I would do my best to numb my mind from the physical pain and numb my soul from the mental pain. The pain signals then increased in frequency and intensity as I was not responding to their message. I began to shut down, dying slowly from the inside out.

When people are in pain, especially chronic pain, it often presents as anger. Anger was one particularly poisonous symptom of my pain which then spread my pain to others like a highly contagious airborne virus.

At that dark lonely time, I was reminded that pain and illness are some of our most powerful teachers. Pain is a product of our nervous system which reveals to us our own limitations. Pain teaches what we can and cannot touch, say or do. Pain also supports us when predicting future outcomes should we make similar choices again. Eventually, my pain completely overwhelmed me both physically and emotionally. It became too brash to be ignored any further. Remembering my pain was a message, I too realized I needed to heed that message rather than suppress it. The message of both my physical and mental pain was simply “you are overdoing it”. My gas tank was empty and I needed to refuel. The way I had been living was not providing me with the opportunity to nurture myself. Lack of self-care had come at a great cost.

I was burning the candle from both ends. I am a single parent to a child who has sleep and behavioral issues. I was run off my feet and exhausted from the taxing combination of my work and home life. Lack of sleep and a high-stress job were taking a serious toll on all aspects of my life. It was in this weakened state I suffered the deepest type of injury, a soul injury. An injury that still affects my daily existence.

Although WCB and similar organizations would like to compartmentalize our lives so they can pick and choose what is compensable and what is not, life does not work this way. Should someone experience a traumatic event in their personal life and then responded to a call that mirrored that experience, likely they would be affected by that event in a more significant way than someone else would be. Deciding if this is a personal issue or a work issue is unclear. What I do recognize is: if we are exhausted and burnt out when attending that traumatic call, we are far more likely to sustain such an injury than if we had been rested, fed, and felt better prepared for that call.

The 2006 ATSB RESEARCH AND ANALYSIS REPORT states that “Driver fatigue remains a major cause of road accidents worldwide. Research has demonstrated that fatigue is comparable to alcohol in terms of performance, impairment, and risks to road safety.”

Just as fatigue is a proven form of impairment affecting driving, I suggest fatigue has similar effects on the ability of paramedics to safely administer potentially lethal medications during high-stress situations with little to no medical oversight.

Driving lights and sirens while speeding and breaking traffic laws is a high-risk activity for all first responders to engage in. Compound this hazard with the intoxicating effects of fatigue and we are sure to find the severity and probability of disaster to increase drastically.

Large portions of paramedicine involve either driving or providing medical interventions. Therefore, by identifying that these major aspects of our job are significantly affected by fatigue we must conclude that fatigue is an issue that requires immediate attention.

I was fortunate enough to have the opportunity to step away from my position and take some time for healing. A period of self-reflection led me to question many things. Was I really in the best position to be helping people? With resources already so taxed, was I more help broken at work or home healing? How much of a risk was I to myself? When does our fatigue become a danger to others? At what point does fatigue become negligence? How much responsibility for change should fall on our leaders and how much on us individually?

Negligence defined is a conduct, or a failure to act, that breaches a duty to take care. By recognizing fatigue in first responders as the enormous safety risk that it is, I sense we became both professionally and morally required to act. Inaction simply put, would be compliancy.

We have already experienced more than enough tragedies and pain to learn from. We have already lost two veteran paramedics, Jo-Ann Fuller, 59, and Ivan Polivka, 65, to a fatigue-related death near Tofino on October 19, 2010. Many of us have watched the enormous weight of this profession devour the lives of the people we love in other ways too: such as physical injury, depression, anxiety, addiction, and even suicide. This proximal devastation surrounding first responders then creates a much farther-reaching wave of sorrow. This wave wreaks havoc on all those caught in its wake. Do we really need to keep receiving the same message time and time again?

“Safety is not an intellectual exercise to keep us in work. It is a matter of life and death. It is the sum of our contributions to safety management that determines whether the people we work with will live or die.”

-Sir Brian Appleton

I lean towards the determination that continuing to work in the current conditions would likely be negligent. A reckless risk of many lives. I care greatly for the welfare of my partners, my patients, and the public at large. I am able to recognize that when I am run down to the point of exhaustion I am at a much higher risk for personal injury. Similarly, I am a much larger risk to the people I encounter each day. Foreshadowing the probability of a tragic outcome I knew I had to do something. After many hours spent alone with my thoughts, I decided to use my art as a platform for social change.

This project was born out of philanthropy. Not in the monetary sense, rather the desire to promote the welfare of others. Still, I found myself terrified to move forward.

I had become fearful of returning to work after my recovery knowing I could not, in good conscience, continue to practice medicine without beginning to turn the wheels of change. I also became fearful of losing my job should I try to speak out. We live in a world crippled by fear. I too was right there in it, beginning to allow fear to shape my life’s actions and inactions. Fear feeds the depression which stifles our ability to experience joy, drains our energy levels, suppresses our creativity, and diminishes our confidence to raise a little hell when there is hell to be raised.

Knowing from experience when I turn toward my fears they dissipate before me like a distant mirage, I did just that. Taking a stance for what I know will save lives has become the focal point that drives me. When we choose to focus on our values, we allow all of the distractions to fall away, including fear.

In the 1950s a Polish psychologist named Kazimierz Dabrowski studied WWII survivors and how they had coped with the traumatic experiences of war. They had been exposed to horrors that most people could not begin to comprehend. Dabrowski began to notice something both unexpected and incredible amongst the survivors. He found a sizable percentage of the survivors studied all believed that the war experiences they had survived, although deeply painful, had actually allowed them to live a deeper and more meaningful life. Some going as far as to say that they believed they are now happier people for having lived through those traumas. Those individuals were able to leverage that unfathomable pain and transform their lives in positive and powerful ways.

In no way do I suggest my suffering is even comparable to those who have endured and survived a war. Still, I aim to transform the pain, suffering, and traumas I have experienced in a similar way. My hope is that my commitment to honest expression through both my words and my art will inspire others to also speak their truth. To find a voice and take a stand against a broken system that seems to care more about the bottom line than the people it was built to care for. To speak out against monopoly employers who threaten to marginalize anyone unwilling to fall in line.

Our profession is devolving as we are not keeping pace with the growth and adaptations required to meet the current demands of this profession. For example, employers are allowed to have paramedics work 12-hour shifts before paying overtime if they provide resting quarters. The presumption was they would be allowed to work longer shifts, but during those shifts, they would have an opportunity to rest. Now that crews are generally busy for the full 12+ hour shift, they do not have the opportunity to decompress from the many stressors faced while on calls. Should rules like this not be reviewed and changed as the profession changes?

We can no longer be disillusioned by the hope that someone else is going to come in and fix our problems for us. We must become active participants in our own healing and growth. Furthermore, to simply choose neutrality because it is easy, is to side with the opposition. Martin Luther King Jr. said, “In the end, we will remember not the words of our enemies but the silence of our friends.”

It is not negative to shout “fire” if you see a building going up in flames. However, it is a grave injustice to watch a building burn in silence while others parish.

Your story matters, and we need to hear it. One story may touch many people, but thousands of stories together would make a wave-like this profession has never before seen. When we stand in unison we become bigger than any employer or corporation. Like pain, we become a force that can no longer be ignored.

Should you have another method of establishing change I urge you to fearlessly take the steps required to make that happen. I will be right be your side, supporting the process.

Do something, do anything. The only thing you can no longer do is nothing.

 

ABOUT THE AUTHOR

“I believe in using art as a platform for social change”

Naomi has been drawn towards the visual arts since she could first hold a pencil. Naomi moved to Los Angeles in  2006  to pursue secondary education in Fashion Illustration. Before completing her art degree,

Naomi was blessed with a daughter whom she is raising as a single mother. Naomi temporarily shifted away from the arts while she studied emergency medicine becoming an Advanced Care Paramedic in 2012. After finishing her education Naomi inevitably felt an irresistible calling back into the world of creativity. Since reconnecting with the paintbrush Naomi has dedicated her life to painting.

Most recently Naomi’s two professional worlds collided in a project entitled “Paramedic’s Call to Action” where she is enduring a personal artistic marathon to raise awareness surrounding the dangers of EMS fatigue. On November 1, 2017, Naomi began a 100-day journey to paint 100 paramedics, posting a new portrait and time-lapse video each day. Be sure to connect and follow Naomi’s artistic marathon on her website, naomifox.ca, or via social media.

@naomifoxart Naomi Fox Art

Canadian Paramedicine

Canadian Paramedicine

Canadian Paramedicine provides a platform for exchanging ideas and innovative programs, emerging news, trends, research, politics, and association information affecting Paramedicine in Canada and around the world.

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