Rob Lawrence: Hello and welcome back to another edition of the EMS Educator podcast. I'm Rob Lawrence. And if you're listening to us right now, go over to our YouTube channel because we are now doing a video version of the EMS Educator podcast as well. So not only can you hear us, you can see us all waving at you as well. So go over there and have a watch. We've just taken on the Riverside software and so we're able now to record in video and on audio, wherever you get your podcast from and whichever platform you're on. Great. So to get us kicked off with today's video and audio edition of the EMS Educator podcast is my good mate, Hilary Gates H. Hi.

Hilary Gates: Hi, Rob. Thanks for the kickoff. ⁓ Really excited to do this new thing, even though I wasn't a fan at the beginning of the video podcast. I've quickly become one because, my gosh, you see me all the time. Yeah, and you and I are twinsies wearing our prodigy vest and our backgrounds are different, so that's important. ⁓ really excited to kick this off today with.

Rob Lawrence: Is that what you look like? there you go.

Hilary Gates: Nicole Hansen from New York who ⁓ has we have a cool origin story for how we found Nicole's work and are super thrilled that while we were talking about her first publication, she was ⁓ already getting published ⁓ with another topic that was equally as exciting. So we're going to talk about both of those things, ⁓ mental preparedness and ADHD in EMS clinicians and especially how EMS educators can. ⁓ tailor their instruction and their design and their classroom delivery to make sure that we are looking into the needs of a neurodiverse learner. So Nicole, thanks for being here. Can you please introduce yourself?

NIcole Hansen: Thanks so much for having me. My name is Nicole Hansen. I am... ⁓ A woman of many talents, I currently manage the EMS, the Long Island EMS division for NYU Langone. ⁓ I have been in EMS for about 15 years and of those 15 years I have also done a lot of education. I've taught EMT as well as paramedics. I do some consulting for EMS on the legal aspect and Yeah, I just also really love doing research and ⁓ as you as you already mentioned I have a couple publications out so...

Hilary Gates: Thank you. Yeah, and the way we got into this is that our resident nerd, Maya Dorsett, was looking ⁓ for some research and some evidence around ⁓ mental preparedness, I think, writing a textbook chapter. I'm going let her tell the story. And found your paper, and then we got in touch and figured out you were ⁓ publishing another paper. So Maya, tell us about that discovery.

Maia Dorsett: you So it's not actually a textbook chapter, it's NAMSP. There's a group within NAMSP who's working on a position statement and resource document on mental health and EMS clinicians. And I was working on writing part of this resource document, particularly on a bullet point about why education related to mental health should be part of an initial as well as continuing education program. ⁓ And when I was doing my literature search beyond kind of like NCBI and PubMed and doing a secondary search in Google Scholar, I found this really fascinating ⁓ dissertation that was written about mental preparedness in education. And there were a lot of, think, really important components of this dissertation. The things I appreciated the most is there was this qualitative analysis that had these summary quotes from people discussing like what did this look like in their education? And the take home really was it didn't look like much. It was rarely done and it was rarely talked about. And I thought that was a very powerful statement. So when we were thinking about EMS educator episodes, I posted ⁓ in our chat a copy of your dissertation. said, one, everybody should read this. I think it was ⁓ super, super valuable ⁓ as an educator and kind of like fueled me to think about how do I ⁓ even expand what we're already doing in our paramedic program. But I think it's like a greater topic at large to discuss like specifically the concept of mental preparedness. And we've done some mental health topics here, but I don't think that we can talk about it enough until ⁓ it's so part of the culture and so part of the curriculum that we don't feel like we need to talk about it anymore.

Hilary Gates: that and Nicole we'd love to hear what led you to that research both the mental preparedness and then the ADHD research. Was it a personal thing for you? it a story? Is there an origin story that way or was that just something that you'd come across in an academic sense?

NIcole Hansen: So mental health has always been my soapbox, I guess, in EMS, where you just see so many people struggling. as an educator, I got very frustrated with the curriculum because it's very short. You're spending an entire chapter talking about how do you identify and manage behavioral problems and emotional distress and patience. And there's nothing kind of going back and saying, but you should also keep an eye on your co-workers or yourself and it's like eat healthy, get good sleep and you're like I work a shift and I you know if I'm working at 2 a.m. what's open McDonald's okay so I'm not gonna be able to eat well unless they bring food with me and I'm not going to be sleeping well, which is not great for anyone's mental health. Shout out to the people who are about night shift. I did it for a few years, and that was challenging. ⁓ I'm a daytime person all the way. But I was like, this really needs a little bit more investigation. ⁓ I originally went into my dissertation advisor meeting with this very ambitious ⁓ overview of what I wanted to do and my advisor came back and said, a good dissertation is a done dissertation. You need to scale this back because I was going to be doing, I wanted to do a mixed method study with interviews and a whole scaling system and she's like, you need to just take a breath. one thing at a time. So I was like, okay, I'm just gonna start, you know, a little notebook of things I'm interested in studying in the future. So we kind of came down to the core of what my goal was, which is mental prepare, my goal for the dissertation, which was mental, mental preparedness. ⁓ And it was just really, unfortunately, I guess the self-fulfilling kind of prophecy of a dissertation because I'd had conversations with plenty of people who had said, yeah, like, I don't know, it's kind of brush over it. We just keep going. And I think we need a little bit more reflection ⁓ on how we can help ourselves before we can help others. So that was that was kind of where that came from. And then obviously, you start doing a lot of reading when you're working on a dissertation. I think the references in my dissertation might be longer than my actual paper. And I found some information about ADHD and how that ties into mental health and I just put it in my book of things I wanted to explore more and kind of brought us to where we are now.

Hilary Gates: It's amazing. ⁓ We're not going to discuss each paper in depth. We'll probably focus a little bit more on the latest research that you've published or the latest publication, which is the ADHD one. So give me some of the nuggets of what you found in that mental preparedness paper for your dissertation and ⁓ takeaways for EMS educators or leaders in the systems that are working right now. ⁓ What can they do to improve?

NIcole Hansen: I think Maya probably put it best that it's not being covered. ⁓ What the best mental preparedness curriculum looks like, I don't know. I know that there are some programs that do a very extensive, like, resiliency program, which from what I was reading has kind of a mixed bag. Sometimes it's very successful, but sometimes it's not. ⁓ I think it's also getting to know who your providers are and who your students in the classroom are, which is kind of how the ADHD study came about, where... you see people who are coming into EMS who are carrying trauma with them. ⁓ Part of the framework for my study was the wounded healer theory that people get into healthcare because they have wounds that they need to heal for themselves and they do that by helping others. So we have a whole group of individuals who are coming into healthcare, not just EMS, who are essentially healing themselves by providing patient care. And that's just setting them up for failure if the organizational structures aren't available for them to get help or to get ⁓ guidance or have talk therapy. And some of the things that I think EMS has clung to for so many years is also not necessarily helpful. ⁓ Like CSID, like the Critical Stress Incident debriefing, I've found papers from the 70s that are saying that it actually promotes the development of PTSD. And we're still incorporating that in the curriculum and you're like, ⁓ well maybe we should reconsider that. Like sometimes forcing people to talk before they're ready is not helpful. You have to have very strong social networks and sometimes some EMS agencies have better social networks than others. Some people have better social networks than others. So, you know, promoting like a sense of togetherness and unfortunately, like EMS, you know, you see the cartoons of like the EMS is eat your young, you kick them out into the field, say good luck, you're fine. and people aren't, like they're floundering and they don't know who to speak to about it. And if like, ⁓ well you're not tough enough for this job, I think we need to kind of get over that mentality and be like, no we're all in this together. We're all struggling with our own things. It might be different. It might not be all at the same time. Like you know, I might have a struggle this week and you might have a struggle next week. But having that... that social network and understanding that, we are seeing things that a lot of other people don't see. ⁓ You're not going to have a conversation with an accountant about the three-car pileup you saw on the interstate and them be like, ⁓ my goodness, that sounds horrible. And you're like, no, it wasn't that bad. It's a completely different mindset. So I think we need to make sure that those connections exist to keep people healthy.

Hilary Gates: said. I was just pausing because there was so much there, Mya or Rob, if you wanted to jump in.

Rob Lawrence: Just last point first of course, you how many times have we now heard that when we go to sort of an EAP or a counsellor we end up traumatising them because of the fact that there's no connection, no connectivity or no understanding of the job that we do and so perhaps you know we have to keep it in amongst ourselves those that have experienced it in order to understand it in order to help that discussion. That really what kind of just hit me with your last sentence there.

Maia Dorsett: Well, I think, know, there's, Gavin said there are counselors who specialize in first responders and I think making that clear as kind of an expectation and finding those resources in your community. know like our local peer support team has a list of people who they recommend, who have been verified, can kind of, I don't know, the things that we are going to talk about. So I'd like to kind of further pursue this kind of connection of, I think the journeys that people take in their research and what they pursue, I think are one of the most fascinating things. How do people end up where they are in studying and asking the questions that they do? So you said there's kind of a connection. You wrote it down in the little notebook when it got kind of sheared away from the dissertation theory, which is I also agree that a done dissertation is a good dissertation. ⁓ Tell us kind of that pathway. So you kind of wrote it down in the notebook. How did you decide? I think there's probably more than one thing in that notebook. Like how did you decide to prioritize that as kind of the next part of your journey?

NIcole Hansen: I found that in my career as a department leadership, was having a lot of the same behavioral, behavioral is kind of a hard thing to kind of describe it, concerns, where people were having... issues with like impulsiveness or ⁓ emotional intelligence kind of perspectives and it kind of got me thinking like this seems to be pretty standard across the board like again, we talk about how EMS and healthcare were kind of a different breed. So you see it and it's like, oh, these are kind of acceptable things. We see, you know, people will come and they'll vent after like a frustrating call or they'll, you know, get very upset or kind of disappointed when that really hot job comes in and they get there and it's not a hot job. It's the stubbed toe at 2 a.m. They're like, oh, it was gonna be a cardiac arrest. And it just got me thinking like, this might be something that needs to be investigated more because it really shifts how you approach a lot of different things, not only just education, leadership and discipline and identifying people's problems, things like subacute burnout. Sure, all know what burnout looks like, right? You're like, you don't want to but there is completely unrecognized symptoms that you're like, hey, what's going on? And... everyone's working three, four jobs and it slips through the cracks a lot. know, you have employees who might be dealing with, you know, stresses at home that's kind of tumbling into their work life because that, you know, compartmentalization that, you know, is not necessarily being sustained. ⁓ So I was having some conversations and people were like, oh, know, like I have ADHD or I think I have ADHD. And I was like, this is very interesting. This is a lot of people, like the birds of a feather kind of flock together vibe. And then I gave birth to my daughter and all of a sudden having a newborn really just... provides a new perspective for you. And all of my coping mechanisms and all of the things that I had done for 30-something years just didn't work anymore. And I was talking to my therapist, which I promote. Everyone should have a therapist, even if they're not, you know, first responder specific, have somebody because I think it takes a lot of pressure off your regular, everyday relationships. And my therapist is like... It sounds like you have ADHD. And I was like, hmm. interesting. So I went and got assessed and I was like that's, I did really well on that test. That was it. I wasn't expecting to do so well on. So you know just and having that like acknowledgement like ⁓ that's it's not just quote unquote mom brain when you're like I can't I can't focus or I can't you know keep do the things that I usually do. It's you find that like when you have those ⁓ those stressors that all of those coping mechanisms start to fail because your resources aren't available. And I think that's kind of what we see with a lot of people in EMS where you have you're working three jobs and all of a sudden you hit this stress level and the coping mechanisms start to fall apart and Who's there to be like hey listen? We're gonna have a little like non-disciplinary intervention Sounds like you're struggling. What do you need? Like I don't think we have enough of that compassion I think we're just have a little bit too much of the suck it up culture ⁓ ⁓ where people don't feel comfortable or secure in having those conversations like, I can't do this today, something has changed.

Hilary Gates: fun fact I was just I might be a woman of a certain age I don't mind admitting this and doing a little research about menopause did you know that post that post childbirth like you're in menopause you're kind of in this like you know state of estrogen deficiency and and struggling with lots of things so that whole mom brain thing of course is real right

NIcole Hansen: you

Maia Dorsett: Yeah

NIcole Hansen: ⁓ And there's also some sort of correlation also that ⁓ women who have ADHD will go into menopause or perimonopause about 10 years earlier than their non-neurodivergent ⁓ counterparts.

Hilary Gates: It kind of sounds like we got another paper coming out of you, Nicole. Okay, amazing. ⁓ I'd love that this idea of birds of a feather and like the patterns that you're noticing is maybe, if I can make this assumption, what drove you to this research ⁓ and that you kept noticing it as a leader. ⁓ And Rob and Maya and I have all had experiences as leaders or been able to see patterns ⁓ and especially in the job we do.

Maia Dorsett: Yeah

Hilary Gates: Now at Prodigy, I'll speak for them because I know this about them. ⁓ We make lots of remarks and observations about the things that we see ⁓ throughout the country and in the world of EMS. ⁓ And they're fascinating, right? And they're things that we want to pursue. So I just want to ⁓ congratulate you for pursuing a passion and pursuing something ⁓ that you clearly, your instinct was correct because of the position that you are in. ⁓ tell us about what the feedback to you was like when you started maybe making these noises to ⁓ folks around you or even your, ⁓ your leadership or, or your folks, ⁓ that were hearing about ADHD and you were saying to them, think I might study this. And, ⁓ and even when you designed the study and started asking people to participate, ⁓ what were their, ⁓ comments to you about ADHD?

NIcole Hansen: I think the very initial ⁓ comment was, yeah, we know. ⁓ Which was really hilarious, because everyone was like, ⁓ yeah, no, 100%. There's definitely, we're all ADHD out here. And ⁓ I was like, well then, OK. I guess we should definitely get a number on this. if, again, it's knowing your workforce, knowing who's coming into your classroom, if everyone else can kind of see, ⁓ yeah, no, we're all ADHD, then maybe we do need to shift something. ⁓ from the beginning of the, you know, career pathway. So I thought that was really kind of kind of funny. ⁓ And then... there was an open portion on the survey for ⁓ comments if anyone wanted to add anything additional. And there were a lot of people who were saying, you so much. Thank you so much for studying this. Like this really needs to be, this needs to be investigated and this needs to, you know, have a little bit of weight behind it. ⁓ And then it was, I presented this as a poster at EMS Expo, the International Scientific Symposium, ⁓ which is just, if you, you have not ever popped by, this is like a promo, as an EMS provider, if you've never popped by the poster presentation, you absolutely should. It's amazing. Some of the research that is amazing. Love them. ⁓ Check out to David Page. I'm going to you virtual high five as just being a real proponent for EMS research. ⁓

Hilary Gates: Shout out, yeah, shout out to Prehospital Care Research Foundation, PCRF, very good. Yep. Yep.

NIcole Hansen: people were coming up and looking at the the poster and looking at the numbers and going yeah, I believe that or I've never been formally diagnosed, but my children have and when I looked at the assessment I had very similar scoring as my children. ⁓ So it's it's clearly something. It's clearly a trend that I think needed to be kind of brought to the surface. You see there seems to be a little bit of research going into healthcare physicians, especially emergency department physicians and their prevalence of ADHD and how they're already above the general population. I'm like, well, has anyone seen the EMS providers? Or as I like to call us, the outdoor cats. EMS week's coming up. Well, we need a slice of pizza and we're ready, right? And some cakes. Exactly. it was really...

Hilary Gates: And some cake. And some cake and a balloon. Yeah, yeah. We'll do that.

NIcole Hansen: guess satisfying is not the correct word, but it was very fulfilling to see that people were really engaging with the research and saying, ⁓ I can see where this came from.

Maia Dorsett: think that's interesting because from an educator perspective, you think, if it's a given, right, that you're in a specialty that's going to attract a high proportion, a higher than population incidence proportion of people with a brain that's gonna work in a certain way, that gives it certain advantages, but also makes certain things difficult, then I think it's the job of the profession, especially since... attrition from a paramedic program. Everybody likes to blame the National Registry and say, the testinart. But it's not pass rates on the registry that are keeping people out of the specialty, right? It is attrition out of the programs and kind of like the failure to pass the programs or to be able to keep in the programs. And that is a complex, multifactorial thing. ⁓ But. academic struggles or having difficulties with the way that things are taught. And I have had lots and lots of students, I have to say, that do not do very well on tests and are phenomenal paramedics, right? Who like struggle in the classroom and have this, I know it's like the secret sauce of like common sense, spatial awareness and the ability to like rapidly think through ⁓ like an immediate. ⁓ problem, but it doesn't necessarily translate into being able to like sit in a lecture or answer a bunch of test questions. There are two like very different and I've thought a lot about like how do we make it so that success in the classroom actually mirrors what it takes to be successful, right? Like out in the world. And I think that there's a lot of people, students I have who didn't have a lot of academic success in high school and may or may not have had academic success in prior. college environments and many of whom did not have any individualized learning programs or medications or any formal diagnosis. I like some of these people, like, I think so their brains, I think our brains are working differently than necessarily the way that my brain work or really the way that the education system is designed to teach a brain of a certain kind. ⁓ So I'm interested in your thoughts on that. And then also, what do you think we do about that? Like, there's some research that people are like, yeah, duh, like we know that. We all joke that we're all ADHD in emergency medicine. Like I'm one of the weirdos. I can, everybody knows, like I can focus on some weird ass problem for 14 hours straight. And that comes from being in the labs. Like I think, and honestly, as somebody who can, who has a brain that works that way, I feel like I'm actually the outsider.

NIcole Hansen: Thanks. Mm-hmm.

Maia Dorsett: in EMS. Like I am actually the weirdo in EMS for some, just like the way that my brain works and kind of like my hyper focus on a problem that I can just like keep working on for 12 hours straight that everybody else thinks is really boring. ⁓ That's kind of a, that's different. Like that's not the kind of like the typical mind of EMS, which is this like rapid problem solving mind. Like I solve this problem, I move to the next problem. I solve that problem, I move to the next problem. So interested in your thoughts.

NIcole Hansen: So I think it's very multifactorial, again, like as you kind of had mentioned, where you have to take a couple of different things into consideration. So one. I also noticed that same trend with students in my classroom where they're saying, I'm here because I was quote, no good in school. And I'm like, you're not no good in school. You were just under stimulated. It's sort of like the joke that I use is like, there weren't enough challenges in the octopus tank. Like if you think of the ADHD brain as an octopus, it needs to be stimulated. It needs to be challenged, but it also requires some level

Maia Dorsett: I think.

NIcole Hansen: of accountability where you need someone who's going to be like, they need more accountability, not less accountability. You need, you know, more reminders. You need the, did you start that? ⁓ Did you make sure that you have a deadline coming up or things that I do with my like staff? If we have like a mandatory training, I will give them a deadline that's three weeks before the actual deadline and then be like, why didn't you do it yet? Like, let's go, come on, get that done. ⁓ I think there also, there's, I just saw something very recently, there was an interview that was saying that students with ADHD will receive 20,000 more negative comments by the age of 14 than their neurotypical peers. So you have people who are coming in who are being told that they're no good at learning. But it's not true. They're just no good at learning your way. They are very good at learning. I can go and give you, you know, whatever it is that you're hyper-focused interested in and that might be, you know, any variety of things and you will learn it and you will be like, you know, it's the kids who are, I will give you every single dinosaur of the Jurassic period and you're like, okay, like there's no ⁓ limitation for what you can learn, it's just how it's being presented. And then you also take in like motivational theory into it, like students who are in the EMS classroom are there because they want to be there and they think they will succeed. So as an educator you have to kind lean into that and say hey you will succeed we will get you through you know why because you want to be here I want to be here and it's just shifting that you know that focus of you're no good at school like ⁓ you're really good at school you just need the tools to be to be good.

Maia Dorsett: Yeah, and I was gonna say, like, I think a lot of people show up who they really wanna be there and they wanna accomplish the goal, but they've received so much negative feedback. And I have all the time, you're like, ⁓ I'm same thing. Like I haven't been academically successful. I haven't been things. And it's like, well, you haven't been academically successful because of the metrics by which academic success is measured and the way that the things are taught. And this is the most like, adult learning you will ever do in your life. Like the things that you're learning now literally will apply tomorrow when you're taking care of a patient. It's a very different, it's a very different type of learning. But I think we do have to battle whether or not people feel like they belong there and whether or not they think they will be successful. Like I think that there are people who start programs with a lot of self doubt about whether or not they're going to be successful. And they just,

NIcole Hansen: Mm-hmm. kind of a picture.

Maia Dorsett: And you have to be really careful about it. You have to transform that self-doubt into like the belief ⁓ that they can be there and that you will help them because otherwise when they get a bad test score or they get that, that is all feedback. That's like a confirmation of a self-doubt rather than a learning opportunity to like analyze what the failures are. ⁓

NIcole Hansen: Mm-hmm.

Maia Dorsett: and figure it out a way for like that individual student to learn.

NIcole Hansen: Yeah.

Hilary Gates: I mean, Maya, that goes to this idea that you have to be a certain type of student to even enter EMS, right? And when I, a lot of people know I was my background, I was a high school English teacher, right? So I was the person who was good at writing, not good at math. I barely made it out of, you know, high school math classes without crying, all those things. And then I realized, when I entered EMS in my 30s, that part of my problem when I was a teenager was my age and my inexperience and my lack of confidence. And when I was 30, I didn't spend from teenage until I was 30 to ⁓ studying math, but I was good at math when I became an EMS student because I was older and I knew how to study better and I knew how to apply myself and I had intrinsic motivation because... I wanted to learn this stuff to take care of humans. And when I was a kid, I didn't care about math because I didn't want to do it. So it's almost like you want them to come to your EMS classroom with a blank slate of their past ⁓ educational efforts so that they are imprintable in a way that they're not coming to you with the trauma or with the feedback that Nicole just mentioned of damage from so many years.

Maia Dorsett: But I think one of the things Nicole mentioned was some of the system design things that you do in your own agency, right? Like I do calendar invites and I set early deadlines and I do all these things. I think sometimes there's multiple perceptions of these things. I also do that. Like if I actually want somebody to show up, and now like, I'm like, when people send me stuff, I'm like, send it as a calendar invite. Don't put the date in the Zoom link and the email and I have to go do all this extra work, right?

Hilary Gates: Exactly.

Maia Dorsett: But, and when I interact with others, it's kind of the way that you structure it. I think there's two components to that. Sometimes people are like, why do I have to do that? That's calling. And you're like, that's not calling. That's just good project management. I think if you develop the skills that help ⁓ people who struggle in organization or attention. and you make that the general operating procedure of how you run a classroom or how you run an organization, you actually help everybody because some of us may not actually have ADHD, but good organization and reminders are good for all of us, because we all have our attention pulled in multiple ways. I don't know.

NIcole Hansen: doesn't hurt. Yeah, exactly. Exactly.

Hilary Gates: Exactly.

NIcole Hansen: Yeah, ⁓ 100%. I 100 % agree with that. And it's funny too, because as I imagine, I have a young daughter and we're doing this school in like... ⁓ tours and one of them one of the the educators had said school doesn't teach you executive functioning. It doesn't teach you. Okay. Well, I have a project that's due next week. I'm gonna start it now and I'm gonna work on it a little bit at a time. It's the Hey mom, it's eight o'clock on Thursday. I have to go to Michael's and I need to make a diorama and like why did you wait so long? It's like cuz I forgot And it doesn't have to be neurodivergent or otherwise. It's just that students aren't necessarily being taught time management, organization, planning ahead. I agree, doing some of these things in the classroom, an EMS classroom, is going to help everyone, regardless of how their brain works. ⁓ And if, okay, you don't like getting the reminders, put them on mute. If you don't think that you need them, then don't use them but the grand, the grand, you know, group is going to benefit from it and then maybe that's something that they'll work into their own life like ⁓ wow this really this really helps me.

Maia Dorsett: Yeah, there's a book, I think it's in this book, but it may be a different one. But I think it's in How Learning Works was this book that I read, and it talked about strategies to make students successful. And when they study the difference between kind of like highly effective people or people who are experts versus novices, the thing that distinguished experts was the amount of time they spent planning something before they did the thing like

NIcole Hansen: you.

Maia Dorsett: The majority of the time was planning and organizing the thing to be successful. And then the minority of the time was doing the thing. Whereas a novice just kind of like did the thing and then tried to fix it on the backend, which we all know is a, like a not great way to go. that's, and if you think about EMS skills and like students, there's things within the classroom, right? think one of the greatest challenges in paramedic programs is like, how do you fit in all your clinicals and your class and your job and the time management and making sure that you're learning experiences over time so that you actually can like absorb things and move on. But if you even think about the role of like a call, I think a lot of us would organize that if somebody spends a lot of time planning how their gear is set up, doing their rig check, preparing, going from dispatch, planning the call, ⁓ then those things go even smoother. And so I think the teaching of how do I plan, like how do I develop habits that set me up to success, whether or not it's how do I time manage my life or how do I time manage and plan a call or how do I kind of do my rig checks, I think that like benefits literally every aspect of the life. And some struggle with it more than others. but I don't know. I think it's the greatest struggle for everyone.

NIcole Hansen: No, I think that's fantastic. Yeah. And a lot of people who have ADHD also have time blindness. The, I'm going to work on this for 20 minutes and then four hours later, you're like, oh no, like now I'm late for a meeting or now I need to go, you know, pick up my child from school or I need to do any of these things. And I think, like you said, setting yourself up for success and taking the syllabus and maybe breaking the syllabus down for a class and saying, you need to read these pages for this class. ⁓ I think there's a lot of different ways that it can be modified to just help everyone in general. Because again, you can have those students who are like, I'm just going to sit down and work on this one thing. And maybe it's successful, maybe it's not. You have students who have never learned how to study, especially people who have never had to study in school, like I was one of those people, like you're like, ⁓ I never had to study. It just came came pretty naturally until you get into a situation where like, this is beyond my skill set, but I also don't know how to study. So how do I make this work? How do I retain that information? And I think that that's also a huge, a huge gap for a lot of students because it's so information dense. There is just so much information in that, you

Hilary Gates: Mm-hmm.

NIcole Hansen: 1200 page textbook and we're like, all right, we'll go memorize it all. And these courses move too quickly for that to really be a successful method.

Hilary Gates: Let's talk about specific classroom strategies a little bit more just because we like to give those takeaways on the EMS educator podcast. ⁓ Nicole, what are some other kind of ADHD or neurodiverse aware strategies or techniques that an educator can implement in addition to making sure you send a calendar invite, not just an email with the invite in it?

NIcole Hansen: No, absolutely. think there's a lot of things. think the first and foremost is really... shifting how you interact with the student, that you're there to support them. You're there as their teammate. Because even if you kind of meant like give them the idea of like, could be on the ambulance with you one day. We're a team. Let's work on this together. OK, this isn't that you failed. You worked really hard. This mistake could have happened to anyone. Let's work on it together to see how we can make it right. There's plenty of tools out there to also kind of help students ⁓ with studying. You can help, you know, kind of direct them to like various AI ⁓ to create quizzes or to help transcribe notes. ⁓ One really kind of basic thing that they can do is handwritten notes. Nothing, no, don't type your notes. Handwritten. There's a direct connection between you writing and it going to your brain. There you go, look at those notes. ⁓ it's a very tiny note.

Maia Dorsett: That's a very small notebook, Rob. That's a very tiny notebook.

Hilary Gates: He's a reporter.

Rob Lawrence: those for those watching, I'm an avid note taker. As Hillary knows, I have notebook number one, notebook number two, ⁓ notebook three, notebook number four. And I have other notebooks hidden away here. So my this was just the notebook of the day. But there are ⁓ there are others.

Hilary Gates: Go ahead.

NIcole Hansen: right. you

Maia Dorsett: It's so itty bitty! It's so little!

NIcole Hansen: It is $2.00 equal.

Rob Lawrence: Yes, yes, well, this is one of those trade show pick it up on desk notebooks, but it worked. So anyway, back to the plot.

Maia Dorsett: It's a baby!

Hilary Gates: Yeah.

NIcole Hansen: ⁓ But yeah, getting students involved in their own learning. ⁓ I obviously can't speak to every EMS program, but I think there's still lot of that quote unquote sage on the stage where we're lecturing, because again, it's very information dense. moving away from straight lecture to...

Maia Dorsett: No?

NIcole Hansen: activities or ⁓ simulation is always good, right? Because we, think one of the things that we've always noticed with EMS students is that you get them into the lab and they're amazing. Like they can tell you every single step, they can tell you what's going on, but you put them on test and they're like blank. Because again, they have that little bit of trauma from like years of in school taking tests and like they just panic. ⁓ kind of teaching them like alternative ways. Like I think one of the things I did in my most recent class is I had a student who kept struggling with tests and I'm like, how are you studying? And he's like, ⁓ you know, I'm just, just, I'm like, whatever you're doing is not working. let's try something else. And I gave them a couple different methods of like, maybe we try this, maybe we try some scenarios and we put it into like something that's more applicable to how you're going to take that information and use it in real life. getting them involved because I think sometimes like the lecture, you're not going to, the brain has got about 20 minutes, right? I think we have a classroom of people who want to be more involved, who want, you it to be broken up or chunked a little bit more. Yeah, I would say there's a lot ⁓ of resources out there and I think it's gonna be a little, for each classroom it's gonna be trial and error and I think each class is going to be different. ⁓ But as long as you're keeping those students engaged with what's going on in the class, you know, that'll keep them moving forward.

Rob Lawrence: think it's interesting, one of the things you said earlier, I quote you here, you said, prior education trauma. I'm starting to think about, we now developing a sort of post-education stress disorder as in all of the stuff you did in junior school, high school, whatever, pick a school, and then you get to your EMS paramedic, medic class, and you are traumatized by what's gone on before. And so maybe I just gave it a name, but I think that PESD sounds like a real thing.

NIcole Hansen: you It, I absolutely believe it is. Every single medic student I've encountered says, I can't do drug math. It's like the first thing out of their mouth, the second you know it's gonna be math day to do drug calculations. I'm like, but you're not doing real math. And they're like, what? I'm like, it's not real math. It's fake math. And they're like, what? I'm like, it's medication math. It's not the same math that you did in school. And it's the same exact math you do in school, but you're you're giving it context. You're giving it purpose. Cause I think that's part of the issue is you have students who are like, When am I going to need to use this? And you're like, well, right now you have a patient who is actively seizing, and you need to figure out how much medication you're giving them. And they're like, oh, this much. And you're like, you just did math in your head. And they're like, what? And you're like, it needs to be applicable. And they think that you see some students who really just all of a sudden get over that previous trauma because they had to learn algebra. And you're like, I get it. I get it.

Hilary Gates: I love that.

Rob Lawrence: Yeah, we're all still waiting for that day we get to the hundredth character of Pi, you know what mean? It's one of those things. Yeah, no, it'll come up eventually one day.

Hilary Gates: No one's waiting for that, Rob. No one. Yeah. Let's circle back, Nicole, to ⁓ this connection ⁓ that you are probably still exploring, but this connection that might show that folks with ADHD or neurodiverse folks have a prevalence toward or higher incidence of trauma ⁓ or

Maia Dorsett: You

NIcole Hansen: Waiting for the real pie.

Hilary Gates: may be exposed and handle trauma differently than ⁓ another population. ⁓ I don't want to necessarily say one is worse or better than the other. Can you talk more about that? ⁓ then we'll sort of conclude with thoughts about what that means for educators and leaders in EMS.

NIcole Hansen: Sure. ⁓ There is a decent body of literature that really explores how individuals with ADHD do experience more trauma. And that could be the 20,000 corrections before age 14, where they're internalizing all of these negative comments. ⁓ It could be... familial trauma because there is a genetic link between ADHD and how that does potentially pass down that they're still exploring on a clinical perspective. So you may have had parents who had emotional... impulsivity as well, who maybe weren't able to manage their anger ⁓ or their emotions, who were disorganized. So there's a lot of potential just childhood trauma. And then there's also the individuals who have ADHD and were not diagnosed, who maybe developed, you know, inappropriate coping mechanisms. There is a significant ⁓ substance abuse issue with individuals with ADHD, lot of self-medicating with alcohol and nicotine and caffeine because it helps their, for them it helps their brain work better. So it's not necessarily that they're trying to self-medicate for one reason or another, but sometimes they notice that their brain works better ⁓ with substances on board. which is also, I don't know, not something we ever see in EMS where we have individuals who chain smoke or drink way too much caffeine ⁓ or drink after shift. Not at all. ⁓ So I think that that exists. ⁓

Maia Dorsett: you

NIcole Hansen: And then you just have the, there's a body of research that's also exploring how ADHD is an antecedent to PTSD, being that if you have ADHD, you are more likely to develop PTSD in the future. There was a very large longitudinal study that was done in 2018 on the US Army and individuals who had a pre-deployment diagnosis of ADHD were more likely to develop PTSD after they were deployed. And now if you figure that PEMS and military have probably a similar high risk profile for being exposed to traumatic incidents, it's pretty, to me it's a really... not a huge leap to say individuals who work in EMS, pre-EMS, they have ADHD, are more likely to develop PTSD after they've been exposed to traumas on the job. ⁓ And we don't talk about the traumas or those traumas are just part of the job, it's fine, it's no worries. ⁓ So I think that as educators we need to like ensure that we are preparing those students and I think part of the Part of the other issue, it's not like an issue per se because I think it's just how the system works, is that we have individuals who are joining EMS at a very young age. In New York, you have to be 17 by the month that you take the state exam. Now, the prefrontal cortex is wildly underdeveloped at age. 17. And that's where you see a lot of issues sort of arise. And we aren't giving these, let's call a spade a spade, children the proper coping mechanisms to deal with traumas. We are not necessarily building the social networks that they need to protect themselves. We don't have formalized mentorship programs where they have a safe person to speak with, or a person who's not going to say like, ⁓ it's no big deal, let's go, let's go out and do some something that is not a healthy coping mechanism. So we think it just kind of starts to pile up on itself where you really need to look at the bigger system and how we can do things better to protect us all.

Rob Lawrence: Fascinating discussion and you know again all joking aside. I am an avid note-taker I have my notebook and the size of this notebook is not important. It's the content within it Maya ⁓ But some of the things that I have noted down as I do it every ⁓ education podcast is I'm going to just stick with this kind of pre-education stress thing of course because we've all gone through k-12 k You know 0 to 12. We've all been freshmen to soft to sophomore to seniors We've studied tests, we've had assessments, we've done multiple choice, we've had grades. In my case, back in the old country, the dreaded, me, written on the top of the paper was enough to induce all sorts of trauma and stress. I'm sure you all had the see me. We can all relate to this, right? What does that get us to? It gets us to medic and adult education when we're arriving, tarred, jarred, jaded. And so for the educators out there, I think it's a real wake up call to work out how we deliver our adult education. to folk that already are carrying that baggage, ADHD or not. I think actually this is one of my big takeaways from today. Hillary?

Hilary Gates: Yeah. And I love, I love see me cause I'm, I'm sorry, Rob, but I wrote that sometimes on the top of my students essays. They didn't like that. I once had, I was so bad. I learned after a few years, one of my students gave me as when they graduated, they gave me a gift and they gave me a bunch of brown pens and they said, we're tired of your red pens. They're very scary. Brown is so much more like so much less scary. And I'm like, I can't believe I'm like, could you have given me purple?

Rob Lawrence: I thought of you doing that. Yes, it was you, yes.

Hilary Gates: And the other one said to another, yeah, I don't know what that was about. Anyway, and another one said to me, ⁓ you once put a little ha ha smiley face on the side of my essay for something I wrote that was clever. And I have been striving to get another ha ha smiley face from you for the entire year. And I thought, I didn't know that I had that effect on you. And they said, yeah, I mean, it was kind of my greatest achievement. Anyway, talk about trauma. Sorry, sorry, students. ⁓

Maia Dorsett: Yeah, I was like, brown?

NIcole Hansen: You

Hilary Gates: Rob, what I love from what you said is this awareness of educators being aware of what students come to the classroom with and their past life experiences. And EMS, unless you're 17, a lot of people start in EMS like I did in their 30s, or it's a second or third or fourth career or a side career. And so as adults and as learners who come to us not with a blank slate, not with no past history of anything, trauma or otherwise, We just have to make sure we're keyed into what they're doing. And I love that when I asked Nicole what are some specific strategies, she's like, talk to your students. Be aware and tell them ⁓ that you are next to them, that you are by their side, that you are in this together, that we're working together, that I'm a fellow adult learner learning ⁓ how to teach you best and how to best prepare you for the field. ⁓ So that's my major takeaway is that compassion and what Nicole is. ⁓ ⁓ striving for.

Rob Lawrence: So we're developing a theme here, Hilary, but Nicole, before we go, give us some final thoughts.

NIcole Hansen: ⁓ is the best worst job we'll ever have. ⁓ There's no other job like it. ⁓ but you are always kind of at that, you know, the front, the front row of someone's worst day. And it shouldn't be the EMS provider's worst day also. We have so many ways that we can prep people ⁓ so that, you know, we're all going home and we're okay at the end of the day. I'm not saying I'm good, perfect, okay. Like let's keep that bar low that we shouldn't be going home.

Maia Dorsett: you

NIcole Hansen: with extra trauma, we should have those connections and those networks available to us. ⁓ I always maintain an open door, open phone policy. I don't care if it's 2 a.m. I tell my staff, give me a call if it's a problem. And think we need, as educators and I think as leaders, we need to just remember that rural human.

Rob Lawrence: Thank you. There were some great words there and I think that's going to be the sound one of the sound bites that we use to really publicize and promote this edition of the EMS educator podcast. Nicole, thank you so much for joining us. And as always, thank you to Hillary and thank you to Maya. If you are listening to us, I say again, please watch us and also please make sure that you like and subscribe wherever you get your podcast or indeed now your vodcast from on the EMS educator podcast. So that was another edition. Remember. Every episode of EMS Educator podcast drops on the first Friday of the month. So we'll see you next month and until then from all of us, bye for now.