Considering Alternative Treatment Options

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“At one point or another, each and every one of us will benefit from the care and protection provided by our emergency services.”

- Prince William

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Prince William, a former air ambulance pilot himself, addressed this message to remote attendees of the annual Emergency Services Festival of Thanksgiving in the United Kingdom in September of 2020.

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“This year, more than ever, we have been repeatedly reminded of the sacrifices made by all those in the emergency responder community as they worked tirelessly to protect us against COVID-19 and keep the country going in the most challenging circumstances.”

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Even though he was referring to the UK, his statement holds true for first responders worldwide. Especially during Thanksgiving, now is the time to be grateful for how much first responders have helped our communities and to understand the challenges they may face.

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First re·spond·er (noun): a person with specialized training who is among the first to arrive and provide assistance at the scene of an emergency.

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First responders are the firefighters, police officers, emergency medical technicians and paramedics that respond to emergencies, accidents, assault and violence, and disasters. The work they do is essential to our communities, but as it is consistently ranked as among the world’s most stressful jobs, they are at a much higher risk of mental health conditions and trauma.

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As the first professionals to arrive on what is a commonly dangerous and chaotic scene, a big part of their job is that they must remain calm as they assess situations, make critical decisions, and offer urgent physical and emotional support. Witnessing daily trauma and adhering to the demands of the job puts first responders at a greater risk for severe and lasting mental health issues.

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More First Responders Die by Suicide than in the Line of Duty

Data by the Substance Abuse and Mental Health Association shows that 30% of first responders will develop depression and post-traumatic stress disorder.

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If left untreated, those mental health conditions can develop into something more severe. In 2017, more firefighters and police officers died by suicide than in the line of duty. But in the midst of the coronavirus pandemic, the mental health crisis has only gotten worse.

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Marc Cohen, executive director of the Emergency Medical Services Association in Wisconsin, spelled out the problem plainly.

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“Our people are committing suicide. It’s reached a crisis, compounded with COVID-19. We need help.”

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These challenging times point out the enormity of this problem that first responders face and highlights the need for novel interventions. At Osmind, we are grateful to work with a number of practices utilizing novel treatments for first responders. Our software helps increase the bond between practitioner and patient and helps practitioners track how their patients are doing remotely, which is especially important for this patient population.

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Ketamine: Breakthrough Treatment for Severe Depression

Christi Myers, M.S., EMT-P, has over 20 years of experience in emergency medicine. She knows first-hand the difficulties that first responders face each day.

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Myers explains that first responders are trained to be vigilant at all times but the scenes they come across each day puts an incessant emotional impact on their psyche. She says that one of the problems is that the constant mental stimulation and heightened awareness prevents first responders from being able to fully go into a restful state, even once they head home for the day.

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Myers explains that ketamine therapy is able to remove that vigilance from the forefront of your mind. Once your mind is quieted, you move from being in a state of constant vigilance to having “moments” of vigilance, so that you can finally start the process of understanding, forgiving, and ultimately, healing.

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She says, “You don’t realize how unconscious you are to certain things until you can look through another lens.” For her, the things that she hadn’t been seeing were “how wonderful [her] life truly [was].”

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As the director and founding partner of Flow Integrative Ketamine, Myers explains that ketamine treatment allows for a deep restoration so that first responders can look forward to going to work again, allowing them to fall back in love with why they started the job in the first place.

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Many ketamine clinic protocols are based on the study results establishing that six ketamine infusions resulted in a large and sustained decrease in depression with an overall response rate of 70.8%. Researchers also noted that suicidal ideation decreased amongst all participants, even in those who didn’t respond to the ketamine treatment.

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Ketamine is a legal and FDA-approved treatment option at many new clinics around the country, which may offer an alternative option for first responders who are, as Myers describes, “the most self-sacrificing bunch of humans,” and they need to be supported, too.

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EMDR: A Lesser-Known Treatment for PTSD

Janelle Edmondson, MSN, APRN, PMHNP-BC, CCTP/CCTP-II, also works to support first responders and knows about the challenges and lack of resources that first responders have available. She says,

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“It’s really a tragedy that this amazing group of people that are here for the community at any moment, all hours of the day and night, but in their worst moments, there’s no one there for them.”

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That’s why she started Phoenix Health, a clinic that prioritizes first responders using a lesser-known, but successful treatment called Eye Movement Desensitization and Reprocessing (EMDR) therapy.

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EMDR is a form of psychotherapy focused on treating trauma by activating both sides of the brain through bilateral stimulation — an eight-phase treatment that combines eye movements with mental reprocessing. The EMDR International Association states that, ”EMDR therapy is designed to resolve unprocessed traumatic memories in the brain. For many clients, EMDR therapy can be completed in fewer sessions than other psychotherapies.”

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A meta-analysis comparing 38 randomized controlled trials compared EMDR to trauma-focused cognitive behavioral therapy (CBT), a highly effective treatment option for PTSD. Researchers found that EMDR was as effective as CBT when treating PTSD, and the study concluded that EMDR should be one of the first-line psychological treatment options.

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Mark Lamplugh is a fourth-generation former firefighter holding the rank of captain, also mentions the problem of unresolved trauma. “The most poignant, personal issue is that personnel face significant problems with processing their experiences, which is made worse with the current pandemic.”

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Edmondson is a Certified Complex Trauma Professional (CCTP-I/II) and EMDRIA clinician licensed to offer EMDR and she explains that for her personally, EMDR therapy “has changed [her] life.” She recognizes that there is usually an event that develops a calling to this line of work, and that place is usually trauma as well. She explains that EMDR allows first responders to reprocess significant amounts of trauma in a short period of time, which subsequently also facilitates the process of properly storing those traumatic memories in the brain. According to Edmondson, EMDR therapy decreases stress levels, as well as reduces the occurrence of flashbacks and bad dreams, which are common after traumatic events.

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Resolving these traumatic experiences and the occurrence of flashbacks, bad memories, or resulting anxiety and depression helps first responders get back to what they love doing — saving lives.

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Communication and Community

The mental health literature explains that resilience is the ability to adapt to adversity, stress, and trauma. More importantly, resilience is a skill that can actually be developed by practicing reorientation, becoming adaptive, focusing on hope, and focusing on social connections.

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Osmind knows that communication and community is crucial for mental health because no one should have to deal with their struggles alone.

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Myers and Edmondson both integrate Osmind software into with their practices because it allows for personal mood monitoring for the patient as well as private communication between the patient and clinician. Practitioners working with first responders should feel free to reach out to see if the software could be a good fit for their practice.

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If any first responder or anyone else is struggling with mental health, check out members.osmind.org to connect with others, and to learn more about alternative modalities for mental health.

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“We all have a responsibility to do what we can to support this community and to remember their efforts to keep us safe, as well as the many sacrifices made by both them and their families.”

- Prince William

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Osmind provide software and insights to help practitioners, patients, and researchers in treatment-resistant mental health such as those working with FDA-approved psychedelic medicine. Their electronic health record software is the #1 software for ketamine practices around the U.S., serving 140+ practices and over 25,000 patients. The software aggregates insights to help clinicians improve how they care for patients and researchers find new treatments. Osmind’s team consists of healthcare veterans and software experts (AWS, Stanford School of Medicine, Stanford Graduate School of Business) and is backed by General Catalyst and Y Combinator. Drop us a line at hello@osmind.org.

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Janelle Edmondson is a Certified Complex Trauma Professional-I/II and Advanced Practice Registered Nurse with a board certification in Psychiatric Mental Health, and EMDRIA Clinician at Phoenix Health, PLLC. She is also the Critical Incident Support Specialist with Tri-Community Volunteer Fire Department, a member of the TN Disaster Mental Health Strike Team, as well as a founding member of the First Responder Suicide Prevention Task Force. Visit mh-np.com for more information.

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Christi Myers is the director and founding partner at Flow Integrative Ketamine and works as an EMT Paramedic. She has served several agencies including the Department of Defense, American Medical Response, Life Flights, San Bernardino County Fire and Sheriff Department, and the Department of Justice, and now works as an EMS Advisory Committee and Educator. Visit flowintegrativeketamine.com for more information.