Compassion Fatigue: Fighting the Battle to Care

A few days ago, while attending a paramedic refresher course, I was exposed to a term coined by Charles Figley in 1995: “Compassion fatigue” is the “cost of caring for those who suffer” (Figley, 1995). While the term was new to me, the concept has been on my mind for the past few years. As our opioid crisis continues to tax our responders at an alarming rate, I have witnessed the effect on some of the best emergency medical providers on this planet. These extremely caring and empathetic heroes have become desensitized to the effects of the disease of addiction. It seems incomprehensive that you can be on the doorstep of death, revived by a dose (or several) of a magic pharmaceutical potion, and do anything to be on that doorstep again … sometimes within hours.

In my urban fire and EMS system, our personnel are giving Narcan® at an ever-increasing rate to the victims of a crisis that has taken over the social fabric of many of our neighborhoods, rich or poor. Our paramedics and EMTs feel like factory workers pushing the plunger of a syringe over and over again while not accomplishing any successful goal. Even 10 years ago, a paramedic would work a cardiac arrest with a focus to “win.” And when they were victorious and obtained a return of spontaneous circulation (ROSC), they had accomplished something. They were also unlikely to ever treat that patient again for a cardiac arrest, and if they did, the success rate was probably diminished, decreasing the odds of treating the patient a third time. Unfortunately, in today’s opioid response system, the EMS personnel can often identify the “person down” by name and know how much of the wonder drug it will take to titrate the patient back to spontaneous respirations.

As a shift commander responsible for 440 personnel on 100 companies, I believe my job is to provide the personnel on the front lines with the tools they need to successfully fulfill their mission: make it home healthy (physically and emotionally). So, I began to think, research, read, and try to understand. As I was reading, I found some wonderful, concise work on the subject of compassion fatigue in Canada by Francoise Matheiu. These two- to six-page papers were an excellent source of education for someone without the background to become an expert. One of the quotes in the paper, “Running on Empty” (2007), hit me hard:

“The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet” (Remen, 1996).

To find ways to deal with compassion fatigue, we first must identify if we are being affected. Are you experiencing an increased cynicism at work? Do you have a loss of enjoyment of your work or career? Do you find yourself hating every time the PA opens? I think all of us have seen these symptoms at one time or another within ourselves or among our colleagues. Fortunately, Dr. Beth Stamm developed a tool that we can use to monitor our “level” of compassion fatigue. This tool, available at, takes just a few minutes and cannot be self-scored.

So, you have compassion fatigue … what’s next? Unfortunately, if compassion fatigue is left untreated, it often leads to a change in careers. Like a parasite that kills its host, it attacks what brought us into this work: our empathy and compassion for others. Fortunately, Mathieu has another short paper out that gives us 12 self-care tips to transform compassion fatigue into compassion satisfaction. Like many of the tools to combat stress-related mental health issues, the tips focus a lot on internal inventory. Finding those things that increase or decrease your compassion fatigue is a key component. But so is finding your “happy place” and making time to get there regularly and especially when your fatigue score is rising. Take an emotional vacation. One of my favorite tips was to Say No (or Yes) more often. I have personally found this to a liberating part of my occupational mental health.

We cared when we started this profession. Compassion for others is what drew us into the job. If we truly love the job, we must fight to keep it. We must fight to keep caring.

Please take the time to read:

Score your level of fatigue:


Rachel Naomi Remen: Kitchen Table Wisdom: Stories that Heal. Penguin, New York, 1996.


Jack Reall is a deputy chief and paramedic with the Columbus (OH) Fire Division. He is a shift commander and manages the Hazardous Materials and Technical Rescue programs. He is a task force leader for Ohio Task Force 1 and an Operations Section chief for FEMAs Urban Search and Rescue System. He also served as the president of IAFF Local 67 for 14 years. He is also a member of NFPA technical committees on protective clothing, special operations, and occupational health and safety.

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