New Zealand’s ambulance officers attend thousands of jobs each year, ranging from routine home call-outs to deadly road crashes. Research estimates one in 10 emergency workers currently suffer from post-traumatic stress disorder – a concerning statistic acknowledged internationally. Teuila Fuatai looks at what is happening locally.

Amanda Van de Westerlo has been a St John ambulance officer for 20 years. In that time, the 44-year-old – who works as shift supervisor and is a qualified intensive care paramedic – has seen a myriad of changes to the emergency service, and her home city of Auckland.

“I was inducted into ‘Suck it up buttercup, you’ll be fine’, Van de Westerlo says. “But I was also inducted into a culture where there was a lot more support in place, whereby there was a staggering of how you progressed through the service – you didn’t go to the next level until you were endorsed and supported by your peers, and your manager.”

Sitting in a small Rotorua hotel room surrounded by fellow ambulance officers, eight pairs of eyes glaze over momentarily – including Van de Westerlo’s – as we discuss how intertwined emergency-response work is with psychological trauma.

The group, in the Bay of Plenty town for a First Union conference, all agree things seem to have become tougher over the years, manifesting in a variety of changes to organisational structure, systems and processes – some better, some worse.

“I’ve worked with some amazing people who worked way back in the day when the things you went to were brutal,” Van de Westerlo says.

“There were no safety measures in place, we didn’t have safety glass, and we didn’t have seat belts. It was brutal the things that they were going to and the things they were seeing. These guys did 20, 30, 40 years in the service. The cracks are there, some of them have completely gone off the rails, but it took all that time to get there.”

Those cracks are being noticed earlier among officers, despite the number of “graphically disturbing” jobs being significantly lower, and Van de Westerlo believes this is primarily because of changes in how officers are being trained.

“When I started… there was a clear expectation that I would work on certain vehicles for the first two years of my career. That would range between doing hospital transfers, working with [someone who had the] same qualification or the next level up. There’d be some lights and sirens, higher acuity jobs, but the majority of our jobs were low acuity.”

Now, transition into the workforce occurs a lot quicker and officers are generally five years younger than when they started 20-or-so years ago, she says.

While the overall qualifications required for new officers are higher, Van de Westerlo warns using that “knowledge base” to justify quicker movement into the job puts staff under a lot of pressure.

“We’ve got so many of our officers with a degree, so they’ve got a knowledge base behind them and they’re already so many steps ahead than what we were 20 or so years ago – but they don’t have that graduated induction into the service.

“A lot of people assume our job … is gory – but actually, for a lot of staff, social issues is the biggest thing. You see families who don’t have enough money to buy food to put into the fridge for the diabetic or for the children, or it’s a family of eight all living in the one room because there is no money to heat the entire house. It’s the story of the geriatric brothers who live in a house, and they’ve somehow slipped through the system – they’re terribly unwell and there’s nowhere for them to go and nobody cares and they’ve been left to become emaciated and chronically unwell.”

More needs to be done to help staff – particularly new members – learn how to cope and digest not just the immediate trauma from a job, but also the impact of poverty and crime in communities officers deal with daily, Van de Westerlo says.

“A lot of people assume our job…is gory – but actually, for a lot of staff, social issues is the biggest thing. You see families who don’t have enough money to buy food to put into the fridge for the diabetic or for the children, or it’s a family of eight all living in the one room because there is no money to heat the entire house. “

In 2015, an Australian expert clinician and research group published the first ever set of guidelines for diagnosis and treatment of PTSD in front-line emergency workers. The guidelines, endorsed by the Royal Australian and New Zealand College of Psychiatrists, states “there is clear evidence that emergency workers have higher rates of PTSD symptoms than the general population and that for many emergency workers, these symptoms are causing significant distress and functional problems”.

The guidelines emphasise the importance of adequate training for clinicians diagnosing and treating PTSD in emergency workers, and the various treatment options available which enable officers to carry out their jobs safely, and live full, well-rounded lives. It also notes that while one in 10 emergency workers is estimated to suffer from PTSD, rates are likely to be higher if retired workers are taken into account.

Barriers to seeking help are also a contributing factor.

Waihi paramedic Jason Wilmshurst, 47, points to wider problems with New Zealand’s mental health system that influence officer attitudes towards seeking help for psychological stress.

Wilmshurst, who started as a volunteer, has worked for St John in roles around the country for 16 years. Before that, he worked for the Wellington Free Ambulance.

“For me, you see the genuine mental health patients in the community – all of us go to weekly people that say they’re committing suicide, but really they’re not, they’re crying for help. The mental health system is so flawed and so screwed, and if they can’t help those guys who genuinely need it, how can they help [those of] us who just need a bit of a guide,” he says.

While St John offers counselling and basic peer support, Wilmshurst believes some of the stress and trauma from the job could easily be addressed with some pre-emptive measures around resourcing and scheduling.

“Working rurally, on a day shift we have nine ambulances in stations throughout the Hauraki-Coromandel. At night time, I’m the duty manager – it’s a role I choose to do … I don’t get paid anything extra – and we go from nine stations to four stations. It’s just really hard at times because I might be single-crewed, or I worry about possibly not having the ability to fix something or to put more resources [up for a job that might come in].

“It’s those things now that stress me more than the job itself.”

Norma Lane, St John director of clinical operations, said in a statement the service wanted to improve support provided to staff for stress-related to work.

“Some of the work our staff carry out can be particularly stressful, so we are committed to continuous improvement of our systems to ensure they are timely and effective.

“St John, like many other ambulance services, is constantly looking to improve the ways we support our people,” Lane stated.

Where to get help:

– Lifeline: 0800 543 354 (24/7), Youthline: 0800 376 633 (24/7), text free to 234 (8am-midnight) or live chat (7pm-11pm)

– Kidsline: 0800 54 37 54 (24/7; Kidsline Buddies available 4pm-9pm)

– Suicide Crisis Helpline: 0508 TAUTOKO / 0508 828 865 (24/7)

– What’s Up: 0800 WHATSUP / 0800 942 8787 (1pm-10pm weekdays, 3pm-10pm weekends) or live chat (5pm-10pm)

– Healthline: 0800 611 116 (24/7)

– Samaritans: 0800 726 666 (24/7)- Depression Helpline: 0800 111 757 or text free to 4202 (24/7)

– If you feel you or someone you know is at immediate risk, call 111.

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