Mental Health – Anxiety and Panic Attacks
When people ask about your most memorable call, the call where you feel like you’ve made the most difference- what comes to mind?
The call that comes to mind for me, I didn’t do any fancy advanced skills, no one was intubated, no meds were given, no IVs started- just my patient, preceptor, and I, talking.
When I was in field internship for paramedic school, the crew I was working with was called to an emotional distress type call with a patient who was struggling with increased depressive episodes and anxiety resulting in new panic attacks. For just under an hour I sat on the floor with them and just listened.
Listened to them tell me what they have been going through, the overwhelming feelings of depression and anxiety, new daily panic attacks they’ve been experiencing, and how they felt lost alone and hopeless. I reassured them that they weren’t alone, asked if they would like me to share my own struggles with anxiety with them, and disclosed some personal struggles, similar feelings and previous panic attacks.
We did some of the grounding tricks together, and slowly their tears stopped, tremors subsided, breathing slowed down, and the look of fear in their eyes dissipated. Once the calmer state took over, they disclosed that they were contemplating suicide and that they had never felt safe enough to disclose this to anyone else before, we discussed options about where and how to get help, resources available, and most importantly that there was no shame in asking for help- that it’s a sign of strength and never a weakness. They received the help that they wanted and needed that day and had someone that they could trust and confide in that day. However, it wasn’t until more recently that I would realize how impactful this one call would be on my career as a paramedic.
With everyone’s lives being turned upside down and we struggle to adjust to a new normal, placed into isolated states, and forced through changes none of us truly thought we would ever go through, these types of calls have become more prevalent. These are also the types of calls where some providers will be dismissive towards the patient, potentially deterring someone from getting the help that they need. Sometimes due to lack of education on mental health crisis, sometimes due to personal attitude, bias or burn out. If you’re dismissive towards these calls due to personal beliefs, let me be very, very clear and blunt- these calls are not about you. So, check your attitude, bias and ego at the door prior to entering these scenes, be the provider that your patient can confide in and trust to disclose their struggles to. However, if you’re struggles with these types of calls is due to lack of education or you just need some new tips and tricks to add to your toolbox, it’s time to discuss a few common topics as well as some things I have found to be effective and helpful over the last few years.
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Common Anxiety Disorders
Generalized Anxiety Disorder, (GAD), is classified as an excessive anxiety or worry about anything from personal health, social interactions, everyday life, work, etc., experienced for the majority of days for at least 6 months. GAD can be seen in almost all age groups and has a wide range of signs and symptoms associated with it. The most common being (Per the National Institute of Mental Health)-
· Feelings of being wound up or constantly on-edge
· Difficulty concentrating & increased fatigue
· Irritable
· Muscle tension
· Difficulty controlling feelings of worry
· Sleep problems – falling asleep, staying asleep, restlessness
Which is different from Panic Disorder. Panic disorder consist of unexpected or triggered panic attack episodes that cause sudden intense fear from a situation or object, causing a person to feel-
· Palpitations, pounding heartbeat, accelerated heart rate
· Sweating
· Shaking
· Numbness/tingling in hand and feet
· Shortness of breath, choking, smothering/suffocating
· Chest pain/tightness
· Impending doom
· Feeling of being out of control
Anxiety disorders are routinely managed by psychologist and psychiatrists by means of psychotherapy (talk therapy, or cognitive behavioral therapy- CBT) or medications (anti-depressants, anti-anxiety medications, and betablockers), or a combination of both. However, in the prehospital environment these are some ways that I have found to be effective in managing and caring for these patients.
Anxiety/Panic Attack Management
- Scene management- clear the room, just you, your partner and the patient. The less stimuli the better, also the less people around the less judgement one experiences when feeling their emotions. Also, on a safety point, assure that there are no weapons or objects that can be used as weapons surrounding the patient (as with any scene).
- Acknowledge their emotions, do not dismiss them. Allow them to feel their emotions, in a nonjudgmental and calm environment. Sometimes people just need to get everything off their chest, let them do this in a safe environment.
- Coach them through breathing AND breathe with them. Don’t just tell them what to do, explain it and do it with them. If they need a visual aid- on the iPhone or Android the app “state” it’s a dot icon, this will also help coach them when and how to breathe. This app will also provide a visual and tactile distraction by watching the screen prompts and the corresponding vibration produced.
- If they’re extremely antsy/can’t sit still, walk with them. If they need to pace around the room, fidget with something, bounce their leg or tap their hands, allow them to, these are all subconscious ways of distraction for the brain. Allow them to move around safely and don’t restrict them. Movement also releases endorphins, which can make people feel happier or calmer.
- Grounding with anxiety/panic attacks- have them point out anywhere from 5 to 10 objects in the room, saying the name of the object out loud. Have them name out loud 5-10 colors in the room and the objects associated to them (“the walls are blue.”). This can take a little bit of time and coaching to start. But slowly they’ll calm down and understand that they are safe.
If they’re not quite at the point where they can do this on their own, you can also find objects for them and have them name the color, shape, patterns, textures of the objects.
Ask them about a vacation they would like to go on, have them describe it, have them talk you through what that place would smell, feel, look like.
(For more on grounding techniques that you might want to try, see the two references below)
These techniques take time, so understand that you will likely be on scene for a bit, but they do work if done correctly and in a nonjudgmental way. Panic attacks can range from mild to extremely severe, and if these techniques aren’t working to the point where the patient returns to a calm baseline state (and your protocols allow for it) don’t be afraid to give these patients small doses of your anxiolytic mediations (Ativan, versed, diazepam, etc. whatever your protocols allow for). Once they are calm, explain to them their options and what getting help in your local emergency department consists of, be honest with them, don’t lie to them.
Make sure that they know that they are safe, their feelings and emotions are valid, understand that getting help isn’t a weakness, or something to be ashamed of, we all need a helping hand at some point or another in our lives. Be the provider that you would want to care for you or your family in their time of crisis.
Hotlines & Mental Health Resources
Share The Load - 1-888-731-3473
Safe Call Now - 1-206-459-3020
Crisis Text Line - Text 741741
National Suicide Prevention Lifeline - 1-800-273-8255
911buddycheck@Gmail.com & Danial Mills - 205-356-2861
References
Raypole, C. (2019, May 24). 30 Grounding Techniques to Quiet Distressing Thoughts. Retrieved from https://www.healthline.com/health/grounding-techniques#bonus-tips
9 Tips To Help You Get Through A Panic Attack. (2016, December 07). Retrieved January 13, 2021, from https://ibpf.org/articles/9-tips-to-help-you-get-through-a-panic-attack/