Because We Care

A Handbook for Chaplaincy in Emergency Medical Services

Russell N. Myers

• Publisher: Progressive Rising Phoenix Press, LLC
• Year: 2021
• ISBN:
  9781950560554
• Edition: 1
• Topic: Education
• Subtopic: Education General

Until now, chaplaincy in Emergency Medical Services has been the terra incognita, the unknown land on the chaplaincy map. Russell Myers gives us the map, making the case for ambulance service chaplaincy-how to think about it and how to do it.

Chapter One
Welcome to EMS Chaplaincy

Ooching into EMS Chaplaincy

After four-and-a-half years in congregational ministry and a yearlong Clinical Pastoral Education^{*1 3} residency at a Level 1 trauma hospital, I was hired as chaplain at United Hospital in St. Paul, Minnesota. Thirteen years later, I got the call from Brian LaCroix. I was familiar with the emotional weight of caring for people in crisis, and thought I was prepared.

Looking back now, I realize that I probably knew about as much then as the general public. Which is to say, not much. I was new to EMS, and assumed that most calls were trauma calls, and that my work would revolve around critical incident stress and debriefing. I thought it was mostly lights and sirens, high drama, and high stress on a daily basis. Now I know that yes, there are lights and sirens, but trauma calls make up a small percentage of the total.

It also became clear to me that some of the people I was there to support were unclear as to my identity and role as EMS chaplain. It would take some time for us to get to know each other. As Lisa Clouzet wrote in “Chaplaincy: Are You called?”:

A few years ago, a board-certified chaplain randomly interviewed people in New York City’s Bryant Park to find out what the word chaplain meant to them. Many simply responded, “A what?” or repeated the question, “What is a chaplain?” back to the interviewer before admitting that they had no idea. Some of those interviewed associated the word chaplain with the military, religion, Catholics, books, and even Charlie Chaplin! A few seemed quite confident in their answers of “a preacher”; “a member of the clergy”; “someone who works in the church”; and “a pastor who serves in the hospital, police department, or fire department.” Except for a woman who stated she was a former chaplain, the majority of adults questioned seemed unsure of their responses.⁴

A physician colleague recounts a visit to a bear sanctuary in Alaska. A ranger there told her that the way a bear will react to you is directly related to its previous experience with other humans. He said he would be terrified to walk in the wild in Glacier National Park, where the bears had people taunt, feed, and put pressure on them. At the sanctuary, the rangers were granted right of way, admired from a distance, slept outdoors, and cooked in a cooking cabin.⁵

Upon first meeting, chaplains often have a similar experience—the way people react to the chaplain is related to the person’s own personal history. Positive, indifferent, or negative responses are informed by their previous experience. The experienced chaplain has learned not to take any of those personally.

Stopping at a gas station to fill up one day after work, I was wearing my jacket with “Chaplain” emblazoned across the lapel. The man behind the counter smiled and said hello. After exchanging some small talk, he nodded at my jacket and asked, “Is that the name of the company you work for?” He had no idea who or what a chaplain was.

***

My EMS position required just one day a week, and I continued to work at the hospital four days a week. I rode with ambulance crews and sat with dispatchers and went to events where I could connect with other employees. I enjoyed learning about a new venue for chaplaincy, though my primary self-identity was as a hospital chaplain with an interesting side job.

A year into the position, I noticed that while EMS involves trauma and critical incidents, it appeared also to include cumulative stress—the chronic, low-level, day in/day out work of caring for people in need. It wasn’t enough for me to function in reactive mode. There was potential to expand and transform the role of EMS chaplain from reactive to proactive.

The business strategy that Brian used is called “ooch.” To ooch is to construct small experiments to test one’s hypothesis.⁶ Rather than jump headfirst, the ooch allows the user to dip a toe in before committing to more. In this case, hire a chaplain on a limited basis, see if it’s a good fit, and test the concept. I didn’t have the vocabulary for it at the time, but I was ooching as well. I kept my familiar job at the hospital while I tested the waters at EMS. After a year, we both were ready for more. My hospital job decreased and the EMS responsibilities ooched up to a half-time position.

At that point, I knew I needed to learn more about EMS as an industry. This is workplace chaplaincy.^{*2 7} In her book Multifaith Chaplaincy in the Workplace, Chaplain Fiona Stewart-Darling highlights the importance of understanding the local and wider context and environment in which the chaplaincy will operate. Chaplains work on someone else’s territory, and so: “In order to develop a chaplaincy that is able to function and deliver relevant activities, we need to understand the world in which the chaplaincy will operate, the challenges and issues that people and businesses face. Chaplains will also need to be aware of the boundaries in which they operate, and adhere to them, as well as respecting the culture and working environments.⁸”

Stewart-Darling writes of recognizing that, in her chaplaincy position in a financial center, “It was important to at least have a fundamental working knowledge of economics.”⁹ Likewise, it was important for me to increase my understanding of the world of the ambulance service. I enrolled in an Emergency Medical Technician (EMT) course, with a goal of learning more about the work that my coworkers do. Auditing the class, I didn’t want to be an EMT, but rather to get a better understanding of the field of emergency medical services. In addition to the course content, I gained a deep appreciation and respect for EMTs and paramedics, who remain calm in difficult situations while providing emergency care. I scored fairly well on the tests but discovered my own limits when faced with the skills portion of the class. I could feel my anxiety rising when I was challenged to respond to the scenarios.

The position remained part-time for eight years and has since grown into a full-time job no longer paired with the hospital. At the time of this writing, the position is shared among three chaplains. We recognize that the concepts and practices of psychological first aid¹⁰ and critical incident debriefing¹¹ and follow-up remain vital yet are secondary to a broader approach and need for ongoing and long-term emotional and spiritual health that instills resilience. Debriefings and one-to-one support remain in the toolbox, along with the work of creating and nurturing a culture of support. Chaplains are one way to provide a means for addressing well-being without giving the message that there is something wrong with you if you struggle to cope with the stress of your job. Stress is a normal response to an abnormal event. The focus is on long-term well-being and not just incidents.

This approach is not unique to EMS. Healthcare in the U.S. is being transformed to focus on preventative care. Businesses of every size encourage employees to eat healthy, exercise, get enough sleep, and tend to their spirituality. It is in the organization’s best interests to provide support and resources for employee well-being. Rather than being seen as an expense, employee support is viewed as an investment. The costs of employee turnover are well documented.¹² These services are provided by a variety of practitioners; I believe chaplains are one of those, and uniquely positioned to serve in Emergency Medical Services.

What Is Chaplaincy?
What Is Professional Chaplaincy?

The word chaplain comes from the early history of the Christian church.

Traditionally, a story relates the compassion of a fourth-century holy man named Martin, who shared his cloak with a beggar. Upon the death of Bishop Martin, his cloak (capella in Latin) was enshrined as a reminder of the sacred act of compassion. The guardian of the capella became known as the chapelain, which, transliterated into English, became chaplain. Today the chaplain continues to guard the sacred and to share his or her cape out of compassion.¹³

With its roots in religious tradition, modern chaplaincy focuses on providing care and compassion in secular settings. Chaplains are found in a wide variety of venues and come with a range of education and training. Many are clergy; others come into chaplaincy from the fields of counseling, teaching, social work, or psychology.

No Common Definition or Standards

Today we take standardization for granted, but it hasn’t always been that way. As Daniel Immerwahr notes in How to Hide an Empire: a History of the Greater United States:

In 1904, a massive fire ravaged Baltimore. Engine companies sped from New York, Philadelphia, Annapolis, Wilmington, and Harrisburg to help. Yet there was little they could do, for when they arrived, they found that their hoses couldn’t connect to Baltimore’s hydrants (or, indeed, to one another’s hoses). For thirty helpless hours, they watched as 1,562 buildings burned.¹⁴

Imagine the scene of a major incident, with requests for mutual aid. The National Registry of Emergency Medical Technicians (NREMT)¹⁵ does not exist; every ambulance service trains and certifies its paramedics to its own standards. Ambulances from different services arrive only to find that they are limited in their ability to assist each other, because each has had different training and uses different equipment. We shudder at the thought. Yet that is precisely the situation in which EMS chaplaincy finds itself. A Google search will bring up many certifying organizations, but there is no single standard for chaplains, and no national registry for EMS chaplains.

***

The Critical Incident Stress Management (CISM)¹⁶ team in our area is a volunteer organization with members from law enforcement, fire, EMS, mental health, and chaplaincy. Some years ago, the team leadership received applications for membership from individuals who identified themselves as chaplains. The CISM leaders themselves came from fields that have clear professional standards and recognized that they were not seeing a common credential for chaplains. They approached the chaplains on the team with a request to set a standard definition of who could serve on the team as a chaplain. They proposed using ordination¹⁷ as a credential.

However, there is no common process across all religions and faith communities for identifying and recognizing leaders. Some Christian denominations ordain after a minister has completed graduate theological education; others ordain prior to the start of a candidate’s formal education and training. Some religious traditions do not ordain leaders. It was obvious that without common use of the concept of ordination and lacking a universal definition among the religious traditions that do use the term, ordination would not suffice as a criterion for chaplains. A different set of standards had to be developed for vetting the capacity of the applicants to serve as chaplains on the CISM team.

This is the same issue facing EMS agencies and any other organization seeking to utilize the services of a chaplain. We are not yet at a place in history where there is a common definition of chaplain. Each employer sets its own standard. The leaders of each organization have to decide the scope of practice, expectations, and boundaries they have in mind for their chaplain. What are the needs? What are the goals? What education, training, and credentials constitute a reasonable hiring standard? In the following pages, I will describe some of the relevant history and issues related to chaplaincy to assist EMS leaders and HR staff in making an informed decision. In the end, each employing organization has to decide what kind of chaplain it wants, and each chaplain has to decide what kind of chaplain they want to be.

In recent decades, professional disciplines such as law, education, and healthcare have increased the requirements for education, training, and certification. Some of the changes are related to specializations. Two examples are teachers and physicians. One might see specialization as preschool teachers, high school teachers, teachers of art, music, sports, and languages. It is the same in medicine. Clouzet writes:

In the healthcare setting, pediatricians (insert specialty of your choice) are physicians. They have studied and completed the requirements to become a physician. But pediatricians are also specialists within the wider field of medicine. Their specialty defines what type of medicine they concentrate on. Pediatricians (or orthopedists, cardiac surgeons, etc.) are to medicine what chaplains are to ministry: specialists within their field.

Just as “physician” is a general term, so is “minister” (or “pastor”). And just as there are many specialists within the field of medicine, so many specialists also exist within the area of ministry. Youth pastor is a specialty; “chaplain” also designates a specialty of ministry.

Chaplains have training and skills that congregational pastors usually do not have. Areas of chaplaincy can similarly be broken down according to where the chaplain ministers. For example, we would refer to clergy who serve in the military as military chaplains, those working in prisons as prison chaplains, and so on.¹⁸

Chaplaincy is undergoing a transition toward increased professionalism with standardized credentia...