About two years ago, highly-experienced and respected Sydney paramedic Sandy Macken changed her name. Or, to be exact, she acquired the alias “Shanti Dharma,” a name she now uses outside the job in her new role as an energy healer. She wasn’t the first of my colleagues to go that way. Since starting as an EMT in 1996 I’ve encountered an increasing number of ambulance medics who devoted themselves to meditation, yoga, natural medicine and various other alternative therapies. One of my first training officers would burn incense at the station, with his morning “Om” emanating through the plant room. And when I was finally posted to the city I met a group of paramedics holding weekly yoga get-togethers. Even now, my close friend and work partner, paramedic Dave McAlpine, remains a committed yogi who goes by the name of “Swami” and routinely begins a shift inverted in some impossible pretzel posture.
Many ambulance workers in Australia seem to recognize the link between mental and physical well-being, actively maintaining their own psychological health. But does our patient care reflect this belief? A huge proportion of the complaints we treat in the out-of-hospital environment are a direct or indirect result of stress and anxiety. Whether a patient is conscious of their anxieties or not, these emotions and the physiological responses they elicit are often the root cause of common symptoms such as hypertension, chest tightness, hyperventilation, headaches, muscle spasms and chronic pain. Stress is now globally recognized as a primary risk factor for major killers like cancer, stroke and heart disease. Harvard University’s Herbert Benson, MD, studied the physiology of meditators and discovered their heart rates, breathing rates, metabolism, blood lactate levels and blood pressures were significantly lower than those of the non-meditating population. Unsurprisingly, a North Carolina study released in June this year found 61% of mental health presentations to hospital ER departments were caused by stress and anxiety. But what about medical complaints? It’s difficult to accurately assess rates of somatization disorder because patients suffering stress-related symptoms are usually entered into hospital data systems under their chief physical complaints. However, there are few medical practitioners who would disagree that psychosomatic illness represents an enormous burden on society and health services.
As a mentor for new paramedic recruits, I often quiz my trainees about what they’ve learned in their paramedic schools or degree programs. Usually I’m told emphasis was given to major trauma management and advanced cardiac care, with very little time at all dedicated to mental health. I accept that emergency work differs from place to place, and some paramedics see far more trauma and severe medical emergencies than others. But the rise of ambulance medics as mobile social workers in high-income nations can no longer be ignored. Like it or not, this is the customers’ demand. Around 30% of emergency calls in the area where I serve are mental health-related, which would be higher yet if somatic symptom disorders were included. So why is the focus of paramedic training skewed toward the physical over psychological? Why do most paramedic courses or bachelor’s degree programs not teach a subject in crisis counseling, or for that matter, meditation techniques?
Every shift I do as a paramedic working in a well-off area of Sydney sees me drawing on skills I was never formerly taught—controlled breathing exercises, creative visualization, the basic tools of relaxation. To combat yet another case of anxiety caused by the pressures of modern life, I often find myself running emergency meditation sessions. Some may argue this is not our place to do. But in reality “our place” is constantly evolving. Never before has the role of an EMT or paramedic been as diverse and encompassing as it is now. In Anglo/American systems, the expansion of preventative and low-acuity skills over the past five years is unprecedented. We are not simply responding to changing demand, but EMS is finally recognizing the importance of a “whole patient” attitude to patient care. Non-medical approaches to complaints like pain, for instance, are largely unexplored territories. While researching my book Paramedico I found medics in various developing nations, where pharmacological analgesia isn’t available, relied on meditative treatment, such as mantras and prayer for pain relief, with surprising success.
Some of us assume prevention is the domain of public health educators and policymakers, but prevention is at the very core of emergency medicine. Our job is to prevent bad outcomes for the seriously sick and injured, the holy grail being the prevention of untimely death. If we address issues early on, especially underlying ones, many emergencies can be mitigated. While low-acuity work should never come at the expense of our response to critical cases, I’m utterly convinced the role of EMTs and paramedics ought to be as proactive as it is reactive. If we accept this, then we need to develop a greater appreciation for the connection between mental and physical health.
In Australia, ambulance services are increasingly focused on reducing hospital admissions by giving paramedics an expanded and more holistic repertoire of skills. We don’t all have to be yogis or energy healers to make a difference. But basic crisis counseling and simple meditation techniques should be essential components of paramedic practice from which both medics and patients will ultimately benefit.
Benjamin Gilmour is the paramedic, author and filmmaker behind ‘Paramedico: Around the World by Ambulance’ (HarperCollins). Watch ‘Paramedico’ the film now at www.paramedico.com.au.