By Tanya Snow, ACP
I always had great respect for my mentor, John Garth. He is genuine; a hard quality to find in today’s society. I have learned a great deal from this soft spoken, tattooed “Legend”. As a primary care paramedic straight out of school and scared half to death, he taught me so many life lessons that cannot be taught in school. He taught me the knack of looking perfectly calm while being so terrified, he taught me not to get caught up in base or company politics, not letting other people’s actions make me a bad person but most importantly, that family is everything — the most prized possession on earth – all lessons learned from an exceptional mentor.
He had the same approach to every call; “treat this person as if they were your own family member,” a professional skill I still practice to this day. I kept in contact with John following my PCP practicum. His mentorship continued as he pushed me to become an Advanced Care Paramedic. This was a daunting thought, being freshly divorced and caring for a young son alone. The idea of travelling four hours per day for one week every month was unappealing. Oh, and there was the $20,000 in tuition. John. With some gentle nudging and a pep talk on what a great Advanced Care Paramedic I would be, he convinced me. I took the plunge. Over the next two years of going to The Maritime School of Paramedicine distance program I spent many days wishing I had not listened to him; school was hard. I mean really hard. If I wasn’t working I was travelling to school and then there were endless hours of studying. To take a week off each month I had to switch shifts with co-workers and pretty much beg, borrow and steal to make this happen. I worked every day for three weeks then spent a week going to school. I did this for over two years. Many of my drives home from school were spent crying. But me being me, too stubborn to quit, I tiredly went forward.
I finally finished and passed all required exams, tests, skills and scenarios. Then I was back on the truck for 460 hours of additional “ride time” training, on top of working a full time job and starting a new relationship. John Garth graciously accepted me back as a student and we were off. Again, I learned many qualities on how to become a great clinician as well as a good person. Things were going great. I had the reassurance of him always behind me watching in case I ventured down a wrong differential diagnostic or treatment path. He epitomized mentorship.
The Turning Point
The day was a typical winter’s day in Nova Scotia; cold, some flurries in the air and I was down with the flu, another great side effect of pushing yourself to your limits … your immune system finally says “we’re done, time to rest.” I texted John Garth and explained I was sick. Of course his reply was “stay home, get better, enjoy some time with your son”. I took his advice, stayed home, went back to bed and hoped this wasn’t going to last too long since I wanted to be so done with school and ride time.
I have replayed this day over in my mind a hundred, no maybe a thousand times. Would my going to work that day have changed the outcome? Would I have made a difference? This was the day my mentor fell.
As I carried on my normal life, John Garth and his family were in their worst nightmare. All I knew was he was off and no one was really telling me what was going on. Finally I cornered a long-term friend and co-worker who told me “he’s in a bad way, he’s not taking phone calls, not accepting visitors and he’s drinking heavily”. I didn’t have to hear those four abbreviated letters to know that he was suffering from posttraumatic stress disorder (PTSD). Mental health disorders experienced by paramedics that result from work-related activities have been called operational stress injuries (OSI) (Carleton et al. 2017). OSI encompasses a set of disorders such as PTSD, panic disorder (PD), generalized anxiety disorder(GAD), social anxiety disorder (SAD), and alcohol use disorder (AUD) (Carleton et al. 2017).
A Plan to Help
While sitting at work one night I said to my partner “I can’t believe there’s nothing we can do to help him”. We help people every day. That’s what we do! Why can’t I help John? It was at that moment I decided there isn’t enough talk and awareness about this awful disorder (or OSI in general) that affects even the most veteran and strong paramedics. I wrote John Garth a letter that night telling him he wasn’t alone and that we are all here for him. I vowed that night that I would start doing education days strictly for the helpers. Until this point most of our local education days were primarily educational pieces on how to treat patients or on the newest interventions. These presentations were typically a power point presentation by a local emergency department physician. There were no education days for us!!! We needed something to “Help the Helpers” and that’s when the hard work began.
I never in my wildest dreams thought I would get so much resistance from people I respected in my field. I had a supervisor ask me “how would you feel if someone attended this education day all about PTSD and went home and killed themselves?” I was so stunned at this, and was left speechless. How would I feel? It would destroy me but that’s the whole reason why we need to do this so people can find out that they are not alone. I needed to show people that nobody is immune to this disorder but life doesn’t have to end with a diagnosis. This education day is to show as many people as I can that there is life after a diagnosis. People are able to return to work with this illness and live each day with fewer symptoms, through counselling, resiliency skills and support. I also got the very same question from a co-workers and a committee member.
As I started this journey of planning the first ever Helping the Helpers education day I found out pretty early that there would be obstacles. Initial struggles revolved around resistance to discussing this topic in such a public forum and a mismatch between my vision and preconceived ideas about the day’s potential outcome. My vision was simple— that this day would raise local awareness, provide a forum for discussion and provide support to those in need. The day would also help create a network of local health-care providers who have experience dealing with PTSD.
Oh the smoke and mirrors. I am good at a lot of things but politics is not one of them. I cannot be diplomatic when I am so passionate about something and mental health is where my passion lies. I had to reassure certain keynote speakers not to offend other keynote speakers as well as reminding everybody all the time that I still work for this company and don’t want to be fired oversomething
they say or someone they may offend. I had to write objectives, then clinical objectives, then phone interrogations and get keynote speakers power points so it could be approved. This went on for about nine months. The first education day was successfully held in November, 2014.
Helping the Helpers Education Day
We use an open form of communication that focuses on creating awareness of the signs and symptoms of PTSD. We promote getting help early and help those identify resources close to them. The earlier we start treatment, the more productive we can be in our communities, at work, and most importantly, to our families. We want to catch these frontline professionals before they become such high acuity that most services in place are limited when the acuity reaches a point of crisis. In Nova Scotia inpatient mental health care has been replaced by outpatient care. John Garth was one of the lucky ones. He had the support of his wife who wouldn’t give up on him and fought for him to go to Halifax and receive the long-term care he needed. This option is not available to everyone. Many people affected by these illnesses return home sometime feeling isolated (Dr. John Whelen). In rural areas, treatment often involves being seen in the ED by a physician who has limited experience treating OSI. This day is truly an educational day to educate us about us. What we excel at in our everyday lives in recognizing signs and symptoms in our patients, we overlook in ourselves, our colleagues and co-workers. We sometimes suffer in silence or watch our partner suffer because we don’t want the world to know “WE NEED HELP.” Three small little words
with so much power. It’s time we took the power away from those words and build resiliency within our profession.
These education days spark strong emotions in our fellow frontline professionals. How could it not? These are our mentors, heroes, friends and co-workers telling their horrific story of their struggles to become “better”. If we didn’t spark that strong emotion then we wouldn’t be getting the strong and memorable message across that “It’s okay not to be okay, it’s okay to ask for help”. It is not our intention to upset audience members so much that they cannot continue their day or cause any unnecessary anxiety, but sometimes the truth is messy, uncomfortable and upsetting.
OSI is devastating to people going through it, as well as their family members and co-workers who feel helpless. It is my hope that these education days are truly a day of discovery and may get people to think about accessing help early and stop suffering in silence, to talk to people who have been to hell and back and find out what resources are out there for them. The best case scenario is that these disorders will be prevented by raising awareness and providing supports.
Coping and resiliency skills are necessary for prevention and for those afflicted. They are key to getting back to living life again. As our education days became more polished and wereached more and more people we decided to have a psychologist on site at all times to help with anyone struggling with triggers or just needing to talk. As we approach our fourth year we have many psychologists volunteering to come for the day to help. The education day is typically held at the Schwartz Auditorium at St. Francis Xavier University at the end of October. We had 278 people attend the last education day. In previous years we had mostly frontline professionals attending but we have seen a change. More and more family members and people who are not frontline professionals are attending (i.e. sexual assault survivors, people who we never think of as being on the front lines like tow truck drivers, snowplow operators, correction officers). In total, we have reached almost 1,000 people directly or indirectly through Helping the Helpers education days.
The biggest benefit of the day is talking to these people who have been struggling and just need to talk to John Garth or one of the other guest speakers who have been there and understand the struggles associated with getting help. They want to know what has worked for them and what options are out there, whether it is medication, therapy dogs, equestrian therapy, cannabis, a naturopath, physiotherapy, a psychiatrist, or a psychologist. At least it’s a starting point.
I feel an overwhelming obligation to continue with the Helping the Helpers education day. People who have attended Helping the Helpers education day state that they take different messages away from the day. I believe that having keynote speakers with different backgrounds and experiences with PTSD lets us provide for a more diverse audience. I’ve been an ACP for eight years now. My mentor, John Garth, provided many lessons in paramedicine that I now share with others new to this profession. One of the most important lessons has been that we need to support each other, we need to be open about talking about mental health within our profession, and we need to be able to pick each other up when our mentors fall. The Helping the Helpers education day was my way of starting this process. John Garth is still an important part of my life and continues to be my mentor. He is a great inspiration to me and others as he now talks about his struggles with PTSD and how he lives with it every day. I know that through this process we have both grown personally as well as professionally.
About The Author
In 2005 Tanya Snow, at the age of 32, decided to fulfill a lifelong dream and become a paramedic. She took her training at The Maritime School of Paramedicine in Dartmouth Nova Scotia. After being on the trucks for three years she decided she wanted to do more and in 2010 became an Advanced Care Paramedic, graduating with honours from The Maritime School of Paramedicine Distance Program in Sydney, Nova Scotia. She continues to work in rural Nova Scotia. Tanya is a certified instructor for St. John Ambulance as well as The Heart and Stroke Foundation. In her spare time she volunteers with a team of OBGYN’s doing medical missions in the Philippines. She is one of the founders of “Helping the Helpers” an annual education day for frontline professionals coping and dealing with PTSD. She is an elected council member in the Town of Mulgrave, as well as a council member for the College of Paramedics of Nova Scotia. She is happily married to her soul mate, Mark, who has helped raise her son Clayton, now a student at Dalhousie University. She is an all-terrain vehicle enthusiast and loves taking the boat out to catch a big trout with her dad. She is probably best known by her peers for decorating the base for every occasion and season.
This article was originally published on February/March 2018 on the Canadian Paramedicine Magazine.
- Carleton RN, Afifi TO, Turner S et al. Mental disorder symptoms
among public safety personnel in Canada. The Canadian Journal
of Psychiatry. 2017; published online ahead of print.
- In-patient PTSD centre needed in Atlantic Canada, advocate says,
- Whalen’s novel puts spotlight on PTSD in armed forces