Cape Town - When Quinton de Monk began working as a firefighter for the City of Cape Town nine years ago, he remembers that accident scenes made him want to vomit.
Today, however, the gory scenes that are part of his daily work are second nature.
“None of us are robots,” the intermediate life support medic said. “I got squeamish when I first saw a dead body. You get used to it.”
De Monk is one of many emergency care workers who have become desensitised to the gruesome nature of the job, said Chris Stein, senior lecturer for the Department of Emergency Medical Care at the University of Johannesburg.
Even after violent scenes, few emergency care workers discuss how the job impacts their emotional state or mental health, he said.
“It’s a stigmatised kind of thing,” according to Stein, who is also president and acting secretary of the Emergency Care Society of South Africa. “Working in this environment, no one wants to own up to being burnt out.”
The reality is that emergency care workers are often traumatised by witnessing the trauma of other people, said Gerrit van Wyk, director of the traumaClinic Emergency Counselling Network. These include everything from motor vehicle accidents and domestic abuse incidents, to fires and medical emergencies.
And the consequences include the danger of workers becoming emotionally detached, negligent and even turning to alcohol or drug use.
Dr Heike Geduld, clinical head of education in emergency medicine at Western Cape Government Health, warned that with burn-out came “poorer patient care and increased potential for adverse incidents”.
Western Cape public emergency medical doctors and firefighters have access to counselling through ICAS Employee Assistance Programmes, Cape Town Fire and Rescue Services spokesman Theo Layne said.
Additionally, after a firefighting or emergency medical unit responds to a violent scene, such as a motor vehicle accident, the unit is supposed to debrief by discussing the matter with one another.
Van Wyk said counselling was often less effective than discussing the issue with one’s support system.
“It’s not like you have to go to the emergency room every time you have an injury,” he said, comparing it to seeing a counsellor after emotional trauma. “What you need most of all is the support and understanding of the important people in your life.”
Berty van Niekerk, emergency medical practitioner and Belfast station officer in Mpumalanga, said psychiatrists were often sent to speak to him and his colleagues, but were not helpful.
“For us it’s a waste of time,” he said. “We need somebody that knows the field we work in, not anyone who just sits in an office and doesn’t know anything about EMS.”
Yet it is rare for emergency care workers to discuss their emotional states with one another after a job, Stein said.
In his four years as an emergency medical practitioner, he said he did not know any of his colleagues who had been diagnosed with post traumatic stress disorder, or burn-out.
“There’s also a macho attitude in the emergency services where you don’t talk about that,” Andrew Makklink, co-ordinator of first-year emergency medical care students at the University of Johannesburg, said.
When emergency workers discuss traumatic experiences with one another, they often ask what their colleagues would have done in the same scenario, to gauge their own reactions, Makklink said.
Emergency medical practitioner Margaret Jacobs said accidents involving children were the worst to see.
“To the people who work with me, they speak about their children and families, and a fear of their children getting into accidents,” Jacobs, who does not have children, said. “When this happens to other children, you ask if it’s a good thing to have children if this can happen to them also.”
For her husband Willem, also an emergency medical practitioner, the scariest part of the job is the fear that it’s a call about someone he knows.
“Every accident you see, there’s an incredible fear of what you’re going to find,” he said. “It might have been your family.”
The couple work 18-hour shifts six days a week, with overtime, because their unit with Waterval Boven Emergency Medical Services is so understaffed.
The couple said they were not offered counselling at their jobs with the Mpumalanga provincial government, and would be forced to pay for their own if they wanted it. Margaret said most of her colleagues were on anti-depressants to deal with the job.
Stein said implementing mental health evaluations for emergency medical practitioners, firefighters or emergency medical doctors would stave off future problems..
Despite the challenges of working as a paramedic, De Monk said he loved his job.
“Somewhere along the line, I accepted the fact that this is what I’m going to see,” he said. “This is what I signed up for.”