First Responders, Healthcare and Being In-Between
South Minneapolis Station 17 Fire Captain Jeremy Norton discusses how First Responders are ensnared by the U.S. model of healthcare | By Kimberly J. Soenen November 18, 2023
(Captain Jeremy Norton in South Minneapolis, Spring 2023. Photo by Carly Danek)
It’s difficult to understand the life of a First Responder. They see what others turn away from, they confront the messy in-between of human strife and circumstance without judgment or blame and they are trained to preserve and restore when others have attempted to do harm or kill. The clock is always ticking as they race into the unknown, hourly.
Fire Captain Jeremy Norton has been a firefighter and EMT with the Minneapolis Fire Department (MFD) since 2000. He was promoted to Captain in 2007 and heads Station 17 in South Minneapolis. After being promoted to Battalion / District Chief in 2015, he then deliberately opted to return to Captain rank in 2017 so he could continue “riding the rig,” which enabled him to return to working in the streets and triaging people in his community directly, rather than working only in an administrative capacity.
Norton has just released Trauma Sponges: Dispatches from the Scarred Heart of Emergency Response (University of Minnesota Press.). Known for his unfiltered, outspoken conversational style and generosity with up-and-coming MFD mentees, Norton has exceeded the average career life expectancy for an EMT and Fire Fighter with 24 years of service clocked. He is not afraid to speak openly about what he has witnessed on the job.
Earlier this year, I read the book manuscript and was interested in speaking to Norton to get his unfiltered take on the state of health, healthcare and First Responders in Minnesota.
On May 25, 2020, Norton and his team responded to a call to assist paramedics in the futile attempt to restore a man’s life. That man was Mr. George Floyd.
Our exchange by email, text and phone has spanned several months. I began our dialogue with the question he is most frequently asked: Why do you do it?
Soenen; You’ve heard the question many times. Why do you do it?
Norton: I was new to Minneapolis and between jobs and careers. I got to know another Washington, D.C. kid, and she had just joined the Minneapolis Fire Department (MFD). She was 23, had purchased a house, had a steady paycheck and health insurance. I had none of that. I was broke, living paycheck-to-paycheck on tips. I'd been teaching junior high and high school literature, but was looking for graduate programs and other ways to make a living. Initially, the Fire Department appealed because of its schedule, its benefits, the opportunities afforded, and a different way to engage the world and be of use.
Soenen: You speak in great detail about what you see, especially in the homes of persons who do not have access to high quality healthcare. What do you witness and how do you manage the mental health stress of the job?
Norton: One of the primary motivations when I began writing this book, when I was a rookie, was to explain to people what it was that Fire Fighters actually do. Meaning, I kept trying to explain to friends and family what my work entailed, and they kept saying, 'But you're a firefighter, right? What's up with all the non-emergency 911 calls?' Exactly! I wanted to wrestle with that question myself, to understand what I/we were seeing, and what it meant. I wanted to appreciate all that I was witnessing, and dig into the complexities and complications of the job honestly.
The longer I did it, the more I saw the larger, deeper connections, what I refer to as the Sociology of Emergency Response—the ways in which race, class, sexuality, and gender shape our healthcare (non) system at this level. You might imagine the stereotypes we confront, when the majority of our calls can be from people who dial 911 for all of their healthcare needs.
We see the end-points of generations of poverty, poor education, illness, dysfunction, despair, thwarted financial options and imaginations. In short, we witness loss of hope frequently and how that effects health negatively.
(Captain Jeremy Norton. Photo by Twin Cities Fire Wire.)
Soenen: What has been your approach at work day-to-day since 2020?
Norton: When a largely white, male, conservative workforce engages people of color, and financially disenfranchised or marginalized people, there is a lot going on. Things are far more messy, and more complicated, than either my liberal friends' pieties or my conservative friends' reductive declarations. That’s a short answer to a very complicated question.
Soenen: What have your learned about blame, judgment and compassion in the context of health and healthcare?
Norton: I argue in the book for a radical compassion. I encourage people to push beyond the surface assumptions, and to appreciate the messy humanity in folks. I also recognize that, much as people erect the “Us vs. Them” divisiveness walls, it’s counterproductive because there are risks to being open-hearted.
This is not work for the earnest or the soft-hearted, despite all the memes championing softness. I am willing to embrace compassion while I recognize that a whole lot of people are going to die badly and there's not a damn thing, I can do about it. I will look them in the eyes, give them respect, see them as they are. They will die and I will keep living; I will go home to my family, and I will return tomorrow to my crew, so we can do it all over again. At least, that’s what I tell myself everyday.
Soenen: Tell us about the quote from Dessa at the beginning of the book and how it informs your life both personally and professionally?
Norton: I'm not sure if I'm an introvert who doesn't mind being around people, or an extrovert who prefers solitude. I'm quite resistant to binary categorization. I'm not good at small talk but am largely unflappable about traumatic events, situations, and stories. My aunt has said I have a deep well of emotional clarity, which might be a polite way of saying I can be detached and overly rational. Working as a Fire Fighter and EMT does not leave a lot of space or fashion or shallowness.
Soenen: You write a lot about being a “trained witness.” You also write "We cannot fix 911. And, frankly, we are powerless to effect true change in human behavior.” Why do you feel powerless after nearly 24 years as an EMT?
Norton: We cannot stop people from smoking, drinking, drugging, bad-driving, junk-eating, medication non-compliance, and other self harm. Many people fail to try to thrive so we often return again and again to the same people who are slowly circling the drain. We cannot force them not to make bad decisions, and we cannot refuse to respond and treat them when they next call 911.
Soenen: In you view, are Americans healthy, health literate people?
Norton: The cycle of poor home-habits of some people for so many reasons lead to ongoing health issues, and frequent returns to the Emergency Department. These people receive help, medication, rest, and interventions and then return home only start again. We show up, we carry people out to the ambulance, the medics transport, the cycle continues.
Soenen: There is a futility in not being able to leverage patients to health and a better trajectory. How do you and your team navigate that feeling of futility and impotency with unhealthy people—whether the poor health is caused by the environment, personal choice, consequences, bad timing or circumstance?
Norton: The systemic level of powerlessness is a weight. We cannot force people to get help, nor can we force the system to truly help the people. The paramedics are obligated to transport almost everyone. Many of the people we see lack the health literacy information to understand the path they're on, whether due to doctors' reticence or a breakdown in communication in the system.
We see the unhoused, the unwell, the sick, the scared, the hurting, the drunk, the drugged, and the despairing. And those populations seem to be ever-growing as evidenced by the increase in the number of calls we receive. But we cannot force the hospital, the medical system and the commercial health insurance companies to change how they operate. We are pawns in a frequently unethical ecosystem.
Soenen: My own life’s work in Health Humanities, Universal Healthcare advocacy and journalism intersects with your book at the epicenter of Do No Harm, meaning we both have an interest in changing the American approach to, and model of, healthcare. EMTs face "reams of insurance and hospital-mandated paperwork” you write, which burns out even the most skilled and dedicated First Responders. How do we prevent burn out, Moral Harm and reverse the medical professional mutiny?
Norton: If we begin with an acknowledgement that for every firefighter, police officer, and paramedic starting their respective careers, we can say objectively that all will sustain exposures that qualify objectively as traumatic damage, then what? The cities and states are hiring people whom they will be guaranteed to payout in three to thirty years for unknown mental health and bodily damages due to their service. 100% of a workforce able to claim a potential long-term disability? I can appreciate the financial gatekeepers' and bean counters' abject horror at such a prospect.
A PTSD / PTS diagnosis is not fatal, nor necessarily career-ending. But with so few precedents, it's very murky. Above all, the fact is that this work will put us in daily proximity to profound sorrows, hardships, suffering, death, dying, and despair. We use tactics and tools of all sorts to combat the despair. Or, some might say, bury it.
Soenen: How do you manage witnessing that trauma day-to-day?
Norton: I think we First Responders went so long ignoring or denying the ill-effects of Emergency Response we were so slow to realize how poorly many of us managed it, and then we really did not have much groundwork established when the seismic change occurred and we were suddenly able—and required—to acknowledge the ills inherent to the work.
Many of the firefighters I've spoken with at peer counsellor trainings speak of the weight and grief they carried from 'failures' to save people. So, it’s not always the trauma, injury and distress but the inability to preserve life. The Hero Myth weighs heavily. I don't blame myself for things that happened before we arrived. I am very clear about that distinction, and, for now, that feels a significant barrier against traumatic injury for me.
Well, think about how many police officers want to 'help people' and 'protect the innocent,' how many paramedics want to 'save lives' and 'help people' with advanced prehospital care, and how many firefighters want to 'help people' and put out fires. Yet, still, all of us spend the majority of our careers running 'emergency' calls that are products of our society's and system's tattered safety net. We are untrained social workers. Think about how that must eat away at the psyches of Emergency Responders. This slow erosion can be challenging intellectually and spiritually. That dark chasm between reality vs. the notional is where the deep crevasse for PTS lives.
Soenen: Because the Commercial Health Insurance industry in the United States has erected countless barriers to accessing healthcare since the 1980’s, and their industry model is Denial of Care, the ER has become the Primary Care Physician for many Americans across the country. For example, the Minneapolis Fire Department has gone from about 35,000 911 calls in 2007 with 434 firefighters, to roughly 55,000 in 2022 with the same number of staff. How does that impact your station and morale?
Norton: Ha! The entire 911 system is in dire need of reform. People call 911 with questions, concerns, uncertainties, or because they don't have access or understanding to a better/bigger context. We race to a house for a “possible heart attack” for someone complaining of three-day ongoing discomfort because they're out of medication or forgot to take their medication or they have a cold. The details, specifics and context clues get lost in the algorithms the dispatchers are forced to use. A lot of it comes down to poor communication coupled with poor Public Health infrastructure.
Sick people get transported back to the Emergency Department from convalescent homes—often because commercial health insurance dictated the length of their hospital stay, not their health—and the understaffed facilities don't have hands or tools to do much more than call 911 for us to show up again and again. This pattern repeats daily. At every crack in the social welfare net, we at MFD are the paltry option to providing high quality Universal Healthcare without barriers.
Soenen: In the chapter called Boy’s Don’t Cry, you go deep into the history of discriminatory law. Why was this important for you to write about?
Norton: My first firefighter friend, Jen Cornell, was instrumental in shaping my interest in the job—and my awareness of the misogyny, homophobia, chauvinism, and racism that shaped so much of the job for the non-male, non-white, non-straight person. A lot has improved but a lot is more complicated than public discourse has the stomach or patience for. I have written a book that examines what I've seen, experienced, and researched in terms of the complicated layers of race/class/gender in Emergency Response. I am not special, not the only, and I can only do my best to speak honestly.
Soenen: Let’s talk about the number one killer of children in the United States: Guns. More and more children and physicians are organizing, activating and mobilizing to enact National Common Sense Gun Laws. The Washington Post this week published the first-ever of its kind visual feature about the aftermath of gun violence. As this legislative battle grinds on, what role do First Responders play in education, advocacy and trauma reduction?
Norton: I grew up in Washington, D.C. in the 70s and 80s, where handguns contributed to the significant (and imbalanced) death toll on young Black men. From a First Responder perspective, a simple point is that guns expedite a fatal, damaging result of an argument, of a split-second error, of rash violence, of despair (suicide). We see the horrific and sad consequences of snap actions and reactions. Someone pulls a trigger and the damage is immediate. So, we see domestic murders, impulsive suicides, gang violence, and male-imposed violence in too many forms (against others, against spouses/partners/ex-es, bosses, coworkers, strangers).
Yes, we respond to kids who've shot other kids, or the child victims of reckless gunfire. There is nothing that will compel those whose ethics or souls are hardened against what seems clear and humane. No amount of the ER carnage, or the destroyed bodies, has been successful at swaying people who turn against the dead kids and innocents with the dead-end defense of a marketing ploy and psychological disorder. This is the country we live in.
“I feel the death of nuance at virtually every turn in our social discussions, political debate, in the faux-reality of social media. The messy middle, the vast gray areas…that is where truth and humanity reside.”
-Jeremy Norton
Soenen: You talk about Thanatos in the book—in Greek Mythology, the Ancient Greek God of Death, but it is not in the way readers might assume.
Norton: I feel the death of nuance at virtually every turn in our social discussions, political debate, in the faux-reality of social media. The messy middle, the vast gray areas…that is where truth and humanity reside. The public narrative ('he's a good man' or 'she's an ogre') demands simplistic and reductive pinches of truth or slanted accuracy. All of us are far more complicated than that. Good people do bad things. Bad people do good things. People love their kids, their parents, their siblings and those same folks also do harm to others. it is complicated. We are complicated. We should resist these reductive narratives. I carry that thinking into the field.
Soenen: What is it like being a father when you work in high-risk work? Do you think it frames your world view and sense of urgency in a way that may be unfamiliar to other parents?
Norton: My elder daughter was an infant when I started and her sister joined us as I was getting a little experienced on the job but still learning. I think about them, and Annie, every shift. I came home from work—esp. the first years, and especially when I worked in poor, marginalized areas—with profound, desperate gratitude for my comfort, for our privilege, for our love.
The juxtaposition I witnessed between the extreme poverty and suffering, the despair, the dead-end-ness, the lack of options, the consequences of generational trauma and suffering…and then my own “happy” little family was overwhelming to me at times. It kept me humble and keeps me humble today. Luck, timing, consequences need to be considered. It is a stark perspective.
“I am a Firefighter/EMT in Minneapolis, Minnesota, a small city in the upper-middle of America. Since 2000, I have put on my poly-blend blue uniform, assembled with a crew of two to five others, then responded to a wide range of emergencies, whenever in the day and night someone nearby called 911. We sit at the station, waiting for people to call for help. Fires are scary and vibrant, impressively dangerous. But the truth is, the majority of our responses are medical emergencies. From birth to death—from pre-birth to post-mortem, actually—we get called to civilians’ crises. I have spent my career immersed in tragedy, suffering, anguish, and loss. All the messy, blurred edges of being human. I deal with the dying and the dead. That is my work.”
-Jeremy Norton
Soenen: What keeps you going?
Norton: Spirituality. I marvel at this world and its wonder and madness, its flawed and broken humanity, its beauty and cruelty. I find most organized religions fatally flawed with their human components. I hope to live so I do right by others, be of use, and find meaning. If there's Judgment, I hope to pass muster. I hope to be surprised. But, I've seen such variations on death, dying, the dead that I feel we are here and then we're gone, but for memories and photographs. That doesn't change how I want to treat people.
Soenen: What impact do you intend to make with Trauma Sponges?
When I first read James Baldwin, in my early 20s, my understanding of the world—and of powerful writing—evolved. My debt to him is profound. I do believe books can start a revolutionary change, not simply by reading books, but because application requires human engagement.
Words can save our lives.
UPCOMING EVENTS
Jeremy Norton is currently on tour discussing his book nationwide. He will be appearing at a special event on December 7th from 6:00-8:00pm CT at the Minnesota Humanities Center. People can attend in-person or virtually. Learn more here.
ADDITIONAL RESOURCES
Minnesota PTSD Help and Suicide Prevention
Minnesota House Passes Bill to Help First Responders with Mental Health