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Paramedics who attended the scene of a crash in Vaughan, Ont., that killed three children and their grandfather, struggled with post-traumatic stress disorder.

Pascal Marchand

When Marco Muzzo killed three children and their grandfather in a devastating drunk-driving crash in Vaughan, Ont., last fall, the tragedy engulfed not only the Neville-Lake family, but also the York Region paramedics who sped to the scene hoping to save lives.

Fire, police and ambulance crews arrived to find an utterly demolished Dodge minivan in the ditch near the intersection, where it had been T-boned by Mr. Muzzo's SUV. Paramedics were at the side of each of the dying victims as they were rushed to various hospitals. In the weeks that followed, eight EMS personnel took a leave for post-traumatic stress disorder.

The unprecedented impact on the service acted as a catalyst for York Region EMS officials to step up internal efforts to bolster support for paramedics called to critical incidents. The changes coincide with a new provincial law that says that PTSD in first responders is an occupational injury automatically deemed eligible for workers' compensation benefits.

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In a Canadian first, York EMS has assigned a specially trained paramedic to travel the region, ensuring employees decompress or seek counselling after dealing with traumatic calls. And for the first time this May, all of the region's 493 paramedics will receive a two-day "road to mental health" education program designed to help them identify PTSD symptoms and develop "resiliency" techniques – everything from controlled breathing to mindfulness training. Other Ontario EMSs have received similar training.

"The biggest effect [of the accident] was that it ignited us to dig in our heels and start engaging strategies" to deal with occupational stress, deputy chief Iain Park said in an interview on the day after Mr. Muzzo was sentenced to 10 years for impaired driving causing death.

The change, however, has been most evident in the organization's culture. "It really marked a shift in the mindset," said Julie Grainger, a York Region tactical advanced-care paramedic who battled PTSD for four years after coming to the aid of a dying York police officer. She never told co-workers of her suffering, but since the Muzzo crash, she says the sense of stigma around PTSD and related mental-health injuries has ebbed noticeably. "No one was questioning anyone else's difficulties."

While some of the eight paramedics have returned to work, neither York EMS officials nor the union will discuss specifics, citing privacy concerns.

Research in Canada, the United States and Britain has found that paramedics experience the highest incidence of PTSD among all first responders, including police officers. Suicide has become a top-of-mind concern. According to 2015 data gathered by the Tema Conter Memorial Trust, a first-responder advocacy group, the suicide rate among Canadian paramedics – 44 per 100,000 individuals between the ages of 40 to 54 – is now 2.5 times higher than that of the general population.

PTSD and related conditions "are part of the job," says Leslie Weeks, a York Region advanced-care paramedic and interim vice-chair of the Canadian Union of Public Employees local. "You're aware those are the risks." But paramedics tended not to discuss any sense of emotional vulnerability, Ms. Grainger, a 19-year veteran, said. "I started in the good old days when it was, 'Suck it up and move on.'"

That macho outlook has begun to yield. While York EMS officials stress that they had been providing psychological support services for paramedics prior to the Muzzo crash, the agency's new approach, to have a specialized paramedic actively approaching employees at risk, is more pro-active. According to former paramedic Vince Savoia, Tema Conter's executive director, York EMS is the first in Canada to take such a step.

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The new training draws on pioneering work done by Australia's Queensland Ambulance Service, as well as programs developed by the Canadian Forces, according to John Anderson, a superintendent who oversees a squad of 20 York paramedics specially trained to identify the signs of a colleague who is struggling or unable to shake a tough call, especially those involving children. "They're often very tense. They're on edge."

Mr. Park also notes that York has moved to ensure that all paramedics who respond to a critical incident have an opportunity to participate in a debriefing immediately after the call – a practice seen as crucial in preventing PTSD. "Having those conversations starts the healing process," he says. With the Muzzo incident, the paramedics involved took patients to several different hospitals and didn't have a chance to get together until a few days later.

Senior York EMS officials are also making more of a point of talking about their own stress-related injuries and PTSD as a means of breaking down the stigma that afflicts many first-responder organizations whose managers prized mental toughness and discouraged displays of vulnerability. Mr. Park openly describes how his own experience dealing with his father's death from cancer served as a trigger whenever he had to make calls to patients suffering from the disease.

While fear remains (as recently as last fall, Alberta's college of paramedics refused to renew the license of an Edmonton paramedic diagnosed with PTSD), more rank-and-file paramedics are also speaking out about their psychological wounds. During the sentencing hearing last fall of the teen who killed York police Constable Garrett Styles in a 2011 joy-riding accident, Ms. Grainger read out an emotional two-page victim-impact statement about the lingering trauma she was unable to shake in the months after the incident.

The day of Constable Styles's death, she'd sought to console his father by telling the grieving man that his son kept his humour until the very end. "It was a flat-out lie." But in court, after years of therapy, she disclosed the horror of those final moments. "I am the paramedic he begged to save his life," Ms. Grainger said. "I was looking into his eyes when his pupils dilated and his heart stopped beating."

That kind of public statement "was the first one that I've seen," said Mr. Anderson, who was present at the hearing that day, but didn't know Ms. Grainger had been receiving counselling for PTSD even though she continued to come to work. "She was profoundly impacted."

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Ms. Grainger said that talking publicly proved to be enormously cathartic and hopes other struggling paramedics will follow her lead. "I felt an unbelievable weight lift off my shoulders. I could breathe again."

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At the sentencing of a young offender for the 2011 death of York police officer Garrett Styles, paramedic Julie Grainger gave a victim-impact statement detailing how the tragic call changed her life.

I had life all figured out. … Or at least I thought I did.

I had been a paramedic for 14 years, and loved every minute of it. I was a strong, confident, caring individual who prided myself in my work, was engaged in my friendships and felt secure in the time I spent away from my husband and young son because of the passion I felt for the job I was doing. I never once questioned the life I had chosen and the path that I was on.

All of that changed in an instant.

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The morning of June 28, 2011, I was 11 hours into a 12-hour night shift. It was a night shift like any other … until I received the call that would change everything.

There has been a spotlight on PTSD in the media over the last couple of years. An increased public awareness about issues that plague emergency responders. Depression, substance abuse, divorce, suicide. But what does PTSD really look like? It looks like the morning of June 28, 2011, to me.

Responding to care for one of our own, injured in the line of duty.

I was responsible for Garrett's care that morning, his life in my hands.

I am the paramedic he begged to save his life.

I am the last person to hear Garrett's voice, to see him alive.

I was looking into his eyes when his pupils dilated and his heart stopped beating.

Like a mama bear fighting for one of her cubs, I gave everything I had. But it wasn't enough.

I stayed with him long after the battle was lost, not wanting to leave his side.

I washed dirt and debris from his face so his family would be able to recognize him in death. I did this all while still holding his cold, lifeless hand.

And I have been forever changed.

I have pushed away friends and family, unable to engage in emotional connections.

I have numbed the pain with alcohol, sarcasm and long hours at work.

My flawless reputation scuffed and my career trajectory rerouted.

Complaints at work, dreading calls out of fear of what I might face, and reckless behaviour.

Flashbacks of that morning plague my days and nightmares keep me from wanting to sleep.

My son now in counselling, affected by Mommy's mood swings and change in personality.

Someone normally passionate about every aspect of life now can't be bothered with many of the things I used to love.

I am not the person I was, nor will I ever be.

Not only do I grieve the loss of Garrett, I grieve the woman I was, because she is also gone forever.

My mother, father, husband and son lost a very important part of their lives that day … me.

And I am just one of the many emergency responders that were on duty the day that Garrett Styles was killed. Our brother.

Police officers, dispatchers, firefighters, paramedics.

Lives forever altered.

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