Carrie Wassel (Host): Good morning, everybody. This is Carrie Wassel. Welcome back to our trauma-informed care podcast here at San Juan Regional in Farmington, New Mexico. The project we're working on today, the topic we're working on, is going to be on workplace advocacy, and my guest is a firefighter and EMT. He's also a U.S. Army veteran and currently works as the operation support manager for the Austin Fire Department. Thank you very much, Philip, for joining us. This is Philip Wassel, who also happens to be my brother.

Philip Wassel: Hey, good afternoon, Carrie. It's a pleasure to be here. Thank you.

Host: Yeah. Yeah, of course. So, I'm going to start off just by doing a little bit of introductions. Tell us a little bit about your military history briefly, and then how long have you been with the Austin Fire Department, and what led to your desire to work there.

Philip Wassel: Yeah. So, I spent a total of 10 years in the Army, roughly three and a half, four on active duty, and then six with the National Guard. I did two 18-month deployments to Iraq predominantly Sadr City, Baghdad, and a little bit southeast. And I got out during my time in the National Guard, joined the Austin Fire Department, mainly to continue serving. The Army can be quite challenging for family life and whatnot, and the fire department you get to stay home most nights. So, that's kind of a nice thing.

But no, just wanted the camaraderie. Everything good that you get in the Army kind of translates very well into police, fire, EMS emergency room care, things like that. So, it was just a really good opportunity to keep serving. And it was also a good change because I had two MOSs in the Army. I was an intel person and an infantryman. And so, I kind of came into the fire medical side. It's just a whole new world to learn, which was a lot of fun.

Host: Yeah, absolutely. Now, for those of you that don't know, most—if not all—firefighters are also EMTs, correct?

Philip Wassel: Yes.

Host: And you also happen to be married to an ER nurse, a nurse practitioner. So, you are well aware of some of the challenges of working in the emergency department and in first responders. Can you speak a little bit to that, how you and your wife handle being first responders and working in EMS and in hospitals?

Philip Wassel: It's a really interesting dynamic, because being on shift work, especially with some of the stresses of firefighting, EMS, and emergency room care, for us, it really works well because we can come home and kind of vent and we both know exactly what we're talking about. We both have the same frustrations and sometimes, you know, that can kind of work against you because you're like, "I'm done talking about the job," right?

But it's nice because we can kind of help each other out. And I have the perspective of bringing the patient to the hospital. She has the perspective from there on, right? And so, it's pretty interesting. The two worlds they're very similar, our level of response and how we problem solve is very, very different. We see the accident and they see the patient more. And so, it's just different perspectives. But I think us sharing those has really kind of given both of us a full-circle picture, kind of a 50,000-foot view of what happens on the side of the road to getting released from the hospital from a patient's perspective. So, it's pretty cool.

Host: Sure, yeah. We can all appreciate the pre-hospital and then the hospital setting. They can be very different. So today, we're going to dive into one of the trauma-informed care principles. There are six of them. And as I briefly mentioned in the last episode, trauma-informed care is more than just taking care of somebody who's been in a car accident. It's taking care of somebody who's had a background of trauma, whether that's that very day in the ER or whether they've been through something horrible from their past and they're struggling with that while they show up for a stomach illness or their diabetes needing management, that type of thing.

So, the principle we're going to go over today is empowerment, and specifically advocating for either yourself, your patient, or one of your colleagues within the workplace. So, what does the principle of empowerment mean to you, and how do you use that at the fire department?

Philip Wassel: I think to give kind of a basic definition with regards to the fire department is the ability to work within our scope, but also have the flexibility to go beyond what is necessarily taught in the academy or things that we learn with continuing education and use our real-life experience, professional judgment, personal judgment to deviate and make decisions beyond what the textbook says or what the policies state. Especially in fire and EMS, that you cannot train for every scenario, right? Like, no two car accidents are the same. You can't always cut the car in the sequence that you learn. It's not a picture-perfect environment. And that's one of the great things about it is no two days are the same, but that also brings a lot of challenges.

So, having leadership, the support around you, and enough flexibility within the policies to really give our tailboards and our drivers and our lieutenants enough leeway to make professional decisions right then and there. So as far as empowerment in the workplace, I think that that would sum it up.

Host: Yeah. So, there's rules and structure in place to go off of, but you have to give people a little bit of trust and wiggle room.

Philip Wassel: Yeah.

Host: Can you give us an example of a time you've needed to advocate for a patient or a colleague on a call when you felt that they weren't being heard?

Philip Wassel: So, I've been in the fire department almost 15 years. I was probably two and a half, three years in at this point, so a pretty junior tailboard still. And we got a call. The call came in as unconscious infant of less than three weeks old, blue, non-responsive, right? So, super bad. Sounds terrifying, right? So, we get there and walk in, and the baby's name was Jack. And baby Jack was fine. He was alert, oriented, and everybody just took a breath, right? But mom is sitting there just crying. Dad's frustrated. They both look like they haven't slept in three weeks.

And, you know, "Hey, what's going on? Why'd you call us?" And we're checking the baby out and everything and asking some questions. And baby Jack was essentially passing out during breastfeeding, and mom was breastfeeding. And it was kind of like, "Huh, that's not normal." And the paramedics came in behind us, so we pass him off to them, but we're hanging out, we're not going to clear on an infant. Nobody's in a rush. And they ask all their questions. And it kind of came around and it was always during feeding time. And my son at this point was about six months old, and he was born with laryngomalacia, which is basically a floppy larynx, and that can cause respiratory issues. Kids grow out of it, it's fine, but it's kind of scary for about three months. And my mother-in-law was a lactation consultant nurse, and she did a lot of work with Shannon, my wife to basically teach Shannon how to feed while Aiden was learning how to feed, right?

So, that personal experience kind of led me to think, "Hey, this doesn't sound like a medical problem. This sounds like a mechanical problem," right? And I'm luckily pretty good at solving mechanical problems. So, I asked her what was happening during feeding and what was he doing? And basically she said, "I'm so sore because he latches on, he eats like a crazy man, comes off, takes a couple of gaspy breaths, gets back on, and we go over and over and over, and then he kind of like passes out. He turns a little blue and passes out." And it'd be like somebody trying to swim laps but only taking one breath per lap. You're going to pass out, right? And so, what baby Jack hadn't learned yet is basically how to eat, stop for a second, take a couple breaths and eat, like we all do without even thinking about it. But he was two and a half weeks old. He hadn't learned that yet.

And the paramedics, basically the option is go to the ER or make an appointment with your nurse practitioner. And even the paramedics were saying, "I really don't know what the ER's going to do, but we're going to take you if you want to go." And she was very frustrated. She couldn't get into her pediatrician for about 10 days, and she was saying What am I supposed to do?" So, I said, "Hang on a second. Let me make a phone call." So I called my mother-in-law, kind of downloaded her with what was going on, and Kathy, she said, "Oh yeah, no problem. I deal with this all the time. I'll have him fixed up in an hour. Send him over." And this was like 11:30, at 2:00 that afternoon they got in, they saw her, and two days later was back on shift. They came by and brought cookies or donuts or something, and just 100% change. And she said that this was a game-changer. Like, basically, she went in, saw Kathy, and just some simple techniques and what to do, what not to do, and the kid's eating like normal. Everybody's getting some sleep.

And so, I think especially in fire EMS world, we really only have a couple options, right? We either transport to the ER or we don't. We're not taking people to their pediatrician. And we kind of forget sometimes, if this person doesn't absolutely need to go to the ER, the ER's an that's an expensive ambulance ride. That's an expensive entry fee into the ER. And it never happens at 11:30 in the afternoon like this happened to be. It's usually at 2:00 in the morning. So, it's terrible. But it was just a really interesting kind of opportunity to call in a favor, but really, really help this patient out who obviously Jack can't speak for himself. Mom has no idea how to fix this, and dad's just looking at us going, "Help," because nobody's slept in three weeks. And we got him in that day. By that evening, everything was fine.

And so, it was just a really cool opportunity, and it made me think, my lieutenant was 25 years in the fire department at the time, and he was like: "Hey, man, good job, because I had no idea what to do." So, it just goes to show, I think we get too centered and compartmentalized in we either transport or we don't. It's ER or nothing. And if we widen our scope a little bit, you know, we can actually do some really good things. And that's part of the empowerment thing that I was talking about with the employer. You know, that's not written in a policy, is call your mother-in-law. It's the flexibility and my lieutenant was like: "Hey, great. You solved that problem. Awesome." So, it is important to have that flexibility from leadership. But it also is important to lean on your own professional and life experience, because we all bring a lot more to the table than I think we think we do.

Host: I like that idea a lot. Like, you don't always know what you know until you're in the moment, and then an experience or a person you met or a conversation you're like, "Actually, I do know the answer to this." So yeah, trust your instincts and think outside the box. I like those. Those are really great takeaways. So, that was a great example of advocating for a patient. Can you tell us about a time you've had to advocate for yourself in the workplace?

Philip Wassel: Yeah. Actually pretty recently, unfortunately, I Had a leadership change at work. And between my experience in the Army and my experience in the fire department, I've seen a lot of genuinely brilliant leadership. On the flip side, I've seen some really, really bad leadership. And so, we had a leadership change and there were some red flags kind of early on.

And throughout the last year, it's just kind of progressively gotten worse. And so, I had to go to my boss, who is on his way out, and any firefighter knows, like, when you're burning time at the end of your career, you're sitting in a seat but you're not actually there. And he's in that role right now.

So, I actually called a friend of mine who's a captain for advice, and he's one of our union reps. And he said, "Yeah, man, let me help you out." And so, we took it higher. And basically, I just knew I needed to extricate myself from that situation and got some help in doing that and moved over to our fleet side of things pretty seamlessly and life is good.

But the important thing was leaning on, like I say, a decade in the Army, 15 years in the fire department and seeing the red flags before they become a professional standards investigation or before careers start becoming involved. And having that discernment and experience takes a lot of time.

And unfortunately, you do have to go through some bad leaders to see them coming. But advocating for myself and my career before it got to a boiling point was key. So, unfortunately, it's going to happen. But having the ability to identify that before it boils over is very key.

Host: And our listeners here run the gamut. I mean, we have new graduates that have just gotten out of school, and we have very experienced paramedics and nurses who have been here for 25 or 30 years. So yeah, knowing when to speak up, how to speak up, the right steps to take is going to be different depending on where you are in your career.

Philip Wassel: Yeah. Like I say, between cumulatively 25 years of experience, I'm in a position where I can kind of see it coming. I instruct a lot at the academy. So, I see a lot of cadets. I see a lot of junior guys going through ADO and PADO.

And what I would tell them is really pay attention to your leadership and try and surround yourself and work for leaders and put yourself in a position of people with the heart of a teacher. And the reason I say that is all of the really good leaders that I've worked for, they may have 25, 30 years in, but they're still teaching the rookies. They're still instructing at the academy. They're still engaged and really passionate to pass along the knowledge. What they're not is the smartest guy in the room. They're not, we call them collar poppers, leaders who remind you of their rank or their superiority to you. Any leader that comes in defining, "I'm in charge. I'm your boss. I'm a superior officer. I'm a lieutenant," or "I'm a captain, so you should do what I say based off of those criteria." That is not somebody you want to work for, ever.

And so as a junior person, if you wind up on a fire truck or an ambulance or an ER and the doctor's coming in just telling you how smart they are and they're so much more trained, so kind of shut up and move to the side, you may not have the flexibility in your career to make a move. But make a mental note, put that in your back pocket and try and follow shadow and get under the wing of somebody who is going to teach you rather than correct you or boss you. Does that make sense?

Host: Absolutely. I think that's really great advice. I hear you saying people shouldn't have to explain their credentials to you to get you to trust them. They should just lead by example. is that fair?

Philip Wassel: Essentially, yes. In a sentence, that's perfect

Host: Okay. The next question: What tools have worked for you, either in the military or the fire department, to get through difficult experiences and keep doing the work of a first responder?

Philip Wassel: One of the biggest pieces of advice, coming from big organizations like Dallas Fire Department, the US Army is control what you can control, because there is a whole lot of things that you've got no control over. And I've seen a lot of good young soldiers, young firefighters get really frustrated, because they're worried about the executive level thing, whatever it is.

And it's like, bro, you can't control that. You don't control whether or not you get the new truck or the station down the road does. You don't get to control so much of this. So if you can keep your world small and control what you can control and learn the basics, be an expert at the basics. And it takes years to be an expert at those basics, right? So if you can do those two things, I think you're setting yourself up really well for success.

It's like everybody's heard about SEAL Team Six and Delta. And if you talk to those guys or listen to podcasts or whatever, they will all tell you they didn't become a tier one unit through magic or because they're just so awesome at everything. They did it by mastering the basics. And it takes reps, it takes years. But I would say if you can keep your world small, control what you can control, and really pay attention whether you're on the side of a road changing a baby's diaper because they got in a car accident or whether you're in the ER doing an IV. Whatever it is, do it better than you did it yesterday. And if you can kind of keep that perspective, you're going to set yourself up for a really good career.

Host: It's easy to get caught up in the big picture stuff and get frustrated. And you know me, I've got strong opinions. And I will happily talk about them for hours. But yeah, just coming back to: what am I good at? What do I know I'm doing well? How can I get better at it? I think those are really, really good takeaways. Yeah. All right. What would you like your fellow EMS and ER colleagues to take away from this conversation?

Philip Wassel: For the, let's say seven years and younger in your career, kind of just what we were just talking about. Keep your world small, follow teachers in your organization and really master your craft as best you can. For the people in more of a leadership mid-level to leadership role, so seven to 25 years, let's say, remember why you're doing it, for one. Because I think burnout happens during that time a lot because people get worried about things they can't control, but very frustrated because they may be a lieutenant, they may be a captain, and they're just beating their head against the wall because of poor policies, bad leadership, whatever. But remember why you're doing it.

And don't always look up. Look down and say, "Hey, how can I help that three-year guy or girl? How can I help that new grad that's just out of nursing school?" And it's his or her third shift in the ER, and they're overwhelmed with the new software program, let alone the code that just came in. And that's something that's helped me a lot, is years one through probably 10, I didn't do a lot of teaching in the academy. And I was in our Austin Fire Department Special Operations. I spent years doing that, and there was a little bit of burnout happening.

And somebody asked me to go down and be a support instructor. And I went down and that's really been not career saver, but definitely a breath of fresh air to be able to go down and teach what I've been doing, you know, for 15 years to the new people. And you get some really funny and obviously a bunch of stupid questions, but some funny and unique questions that kind of make you chuckle and you're like, "I remember when I was that dumb," and it's a lot of fun. And, of course, I'm joking, but it's a lot of fun and it kind of keeps you young. Don't just hang around the old guys all the time.

Host: All right. Final question that I like to ask everyone. And this does not have to be in your current role at all. What is the best job you've ever had and why?

Philip Wassel: I'm going to get crushed for this answer by every firefighter listening, because the right answer if you're a firefighter is being a firefighter. But if I could have this job stateside, I definitely would've done it for 30 years. But I was on a tactical HUMINT team in Sadr City, Baghdad from '04 to '06. And it was bittersweet because I kind of wish I had had a deployment under my belt before I got this job, because it was so unique and such a level of freedom that most young soldiers on their first deployment don't get. Because a THT should have a warrant officer, a senior E6 or E7, so a guy with like 15 years in an E5 sergeant, and then one junior enlisted.

My THT had an E5 sergeant, so brand new buck sergeant, me as a "senior private first class," that's not even a real thing, and then we had like two E1s. And so, I was doing the job of a senior E6 or an E7. And we didn't wear rank, we didn't wear name tapes. It was a pretty unique assignment, but there were four of us, and we supported a couple of different battalions. But our job was basically to find the bad guys and find the bombs, find the ammo, weapons, things like that from an intel side of things, and we were cross-trained in infantry as well. So essentially, we put together target packages. We collected intelligence from HUMINTs typically, some SIGINT, and built a target package, waltzed into the lieutenant colonel's office as an E4 and basically said, "Hey, sir, this is what I need. Here are the resources I need. Do I have your permission, yay or nay?" And most of the time, it was yay, and we'd go at 2:00 in the morning and hit a house or hit a wherever. And we did some really good work. We took out the eight of clubs on the deck of cards, and we captured the lead financier who was financing EFPs, which are a really dangerous roadside bomb being manufactured in Iran coming across the border into Iraq.

And so, we were able to capture him, found a lot of weapons, and hit a lot of houses. So, it was a very unique experience in the Army, where most of the time you just don't have that freedom of movement and freedom to kind of set your own—not rules, I'm not going to say rules—but really set our own mission tempo. And it was great. We were outside the wire six days a week usually, and knocking on doors and it was a lot of fun. But yeah, that was the most fun job with definitely the highest level of individual responsibility, especially for a young soldier like I was at the time. Yeah, it was very cool.

Host: Sounds like a lot of problem-solving and thinking outside the box and a lot of responsibility.

Philip Wassel: Yeah. Yeah. But between the challenge and just the excitement factor, it was definitely pretty cool.

Host: Well, Philip, thank you so much for joining me. I really appreciate your perspective and your advice, and I hope that the people listening enjoyed our conversation and have some things to take away from it. So, thank you so much for being here

Philip Wassel: Absolutely. Thank you for having me. I appreciate it.

Host: Yeah. Stay tuned next month. We're going to have our next guest who used to be an EMT and moved to the dark side of being a nurse, and we're going to talk about burnout and compassion fatigue. So, thank you for joining us, and we'll be back next month.