After a Bad Call

• Take time to process. One study showed 69% of EMS personnel do not have enough time to process after a bad call. This processing might occur in the context of formal critical incident stress debriefing (CISD), in which the group of responders meets and participates in a facilitated discussion about the call. Some find this method helpful, but others find it intrusive and actively harmful. In some situations, CISD can add to the trauma of a bad call. Be mindful that less-formal peer support and just spending time together may have a greater positive impact.

• Talk to someone. Over three quarters of police officers have experienced traumatic calls, but less than half tell their agency. Talk to someone. It doesn’t need to be a drawn-out discussion about your experience, but a senior colleague or peer support network will be able to point you towards the resources your service makes available to you. They may also be able to offer insight on their own experiences with bad calls. If you aren't comfortable speaking with someone from your service, there are resources listed on our Get Help page. 

• Be kind to yourself. Our normal is different from almost everyone else. Whatever it took to shake you was a lot, whether it’s one bad call or an accumulation of trauma. 

• Get active. Traumatic events are associated with an increase in stress hormones such as adrenaline and cortisol. Exercise can decrease these hormones and increase endorphins, leading to feelings of relaxation and optimism. Sometimes, it can also feel as though we need to keep moving and just do something after a bad call. Exercise can be a productive way to make that transition and settle down when you’re still feeling very ramped up.

• Practice meditation. Meditation can slow your body down and reduce adrenaline. It is, in effect, mental exercise. It can also be a good way to transition from a bad call back into normalcy.

• Limit substance use. Alcohol or drug use is not a good way to process trauma. Alcohol use as a coping mechanism has been associated with higher levels of post-traumatic stress.

Often, bad calls are the ones we tend to think the most about—what could we have done differently? This kind of counterfactual thinking is often (but not always) triggered by a combination of a few things.

• There may have been a bad outcome. In the world of first response, this is often death, although it could also be a misdiagnosis or other adverse outcome.

• It may have been a type of call that you don’t run very often, a departure from the “typical” call that you run every day.

• You may feel there was something more you could have done for the patient or person.

• You might see a connection between something you did (or didn’t do) and the outcome of the call.

Counterfactual thinking can be useful for us. It offers ways to improve upon how we run calls. However, it can also promote rumination and feelings of guilt.

When a bad call has more significant effects on our lives, it is called post-traumatic stress. In one study, a third of firefighters showed symptoms of post-traumatic stress. They can include the following:

• Intrusive or repetitive thoughts of the event

• Avoidance of things that remind you of the event

• Irritability, anger, feeling “on edge”

• Disproportionate feelings of guilt or shame that may extend to other parts of your life

Experiencing symptoms of post-traumatic stress is not an uncommon response to trauma. Depending on the severity of symptoms and the ways in which they interfere with daily life, treatment can range from peer support to speaking with a health care provider to inpatient support. In Vermont, post-traumatic stress disorder in a police officer, firefighter, or ambulance worker is covered under workers' compensation unless shown to be unrelated to the job. A trusted senior colleague or peer support network can provide access to resources within your department or area. There are also resources for help on this website.