Friday, April 5, 2024

Psychological Challenges of being an Emergency Medical Service Provider


The job of an Emergency Medical Service (EMS) provider is inherently stressful, involving constant exposure to human suffering and trauma. This can lead to psychological challenges such as depression, anxiety, and posttraumatic stress disorder (PTSD) among EMS providers. Shifts as an EMS provider can vary drastically in terms of call volume, and providers are often working outside in harsh weather conditions at all hours of the day. Emergencies can occur anywhere, from public locations like streets and shopping centers to intimate settings like private residences or nursing homes. Additionally, EMS providers may encounter violent or traumatic situations while on the job, making their work even more challenging. Repeated Exposure Trauma, the severity of the incidents that EMS providers are involved in, and the emotional skills needed to cope with Cumulative Trauma can lead to Compassion Fatigue, Secondary Traumatic Stress, Vicarious Trauma, Burnout, and PTSD. Cumulative trauma refers to the psychological, emotional, and physical distress associated with repeated exposure to traumatic events, either directly or indirectly. Every individual's experience and risk of developing PTSD is unique; some may go through years of service before displaying symptoms, while others may not have an immediate impact, just additional cumulative trauma.

A study from 2018 found that paramedics have the highest rate of PTSD. This is likely due to the top three stressors universally associated with poor mental health, include career challenges, financial struggles, and lack of sleep. Considering the long shifts, standard pay rates, and exposure to traumatic events, it's not surprising that EMS providers are considered high-risk for developing mental illness.

Shift lengths and rotations vary depending on each EMS agency's policies. Typically, shifts can last 12, 16, or 24 hours. Working irregular schedules disrupts providers' natural sleep patterns and can lead to exhaustion. Many providers also work overtime or hold multiple jobs to make ends meet, resulting in back-to-back shifts and further fatigue. While lack of sleep and financial concerns are common issues for EMS providers, the nature of their occupation is the biggest contributor to an increased risk of mental illness.

With the increase in disasters around the world, the demand for EMS providers is higher than ever as they play a crucial role in disaster management systems. However, an estimated 69% of EMS providers report not having enough recovery time between traumatic incidents. Most EMS providers are expected to be on duty for strenuous amounts of time—up to and beyond 24 hours. The duration and intensity of being on call, engaging in extremely stressful situations, and having little opportunity for rest in between incidents can lead to burnout.

Although EMTs and paramedics are often the first responders, they are not the only ones in the EMS chain suffering from burnout. Reports show that other EMS personnel are also experiencing increasing levels of burnout within the industry. Nurses who face moral distress have reported feelings of emotional exhaustion and depersonalization - two key components of burnout. The job of an emergency dispatcher may not require them to physically enter a scene, but they still face daily challenges and trauma that can take a toll on their mental health. Emergency Dispatchers, who act as the vital link between individuals in crisis and first responders, are responsible for dispatching assistance to both emergency and non-emergency situations. They must remain levelheaded and composed while handling multiple tasks and finding solutions on the spot amidst dangerous and heartbreaking situations such as home invasions, domestic violence incidents, fires, car accidents, and even murders.

According to recent findings from the Pulse of 9-1-1 State of the Industry Survey, 74% of respondents reported staff burnout at their 9-1-1 centers, with many displaying symptoms of anxiety, fatigue, and low energy levels.

Moral distress is a major issue within the medical community and it comes as no surprise that it contributes to mental health problems among EMS providers. Despite the patient's decision, EMS providers must respect their choice, even if it may result in their death. One common ethical challenge arises when competent patients refuse assistance that could benefit them. In fact, a study revealed that 27% of ethical conflicts during paramedic responses were due to issues with informed consent. EMS providers may feel a sense of duty to respond and may struggle with moral responsibility to provide care, even if the patient denies treatment or transport- regardless of medical advice. This can lead to moral distress for EMS providers who have good intentions but cannot act upon them. The consequences of moral distress can be significant, such as burnout, job dissatisfaction, high turnover rates, and emotional detachment from patients - all of which ultimately impact patient care.

The effects of burnout, moral distress, and cumulative trauma are not limited to EMS providers; they also affect Emergency Department (ED) nurses and physicians.

Unfortunately, EMS personnel, like other first responders we’ve discussed, are often the last to admit they need help, as it goes against their role as providers of support rather than recipients. Seeking help is often stigmatized or seen as a weakness in this community, where toughness is essential. However, it is crucial for first responders to know how and where to find help.

Support mechanisms, the removal of the stigma associated with experiencing emotional distress, and education about good mental health being just as important as good physical health need to be available and easily accessible to all first responders.


If you believe change is possible, you want to change, and you are willing to do the work, you absolutely CAN get your life back.”

Get your copy of The Soldier's Guide to PTSDThe Soldier's Workbook

or Acknowledge & Heal, A Women's-Focused Guide to PTSD

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