EMS workplace stress and warning signs

Your partner seems to be struggling both on and off duty; did you make the right call?

The situation in the scenario is all-too-common. EMS providers, along with their brothers and sisters in the fire service and law enforcement are asked to respond, remain calm and render care in the midst of emergency situations on a daily basis. It becomes easy to simply characterize this as someone else’s emergency and continue forward with the belief that these experiences do not affect the involved responders.

The culture within EMS is not universally conducive to supporting practitioners. Some EMS systems play host to a culture with a "suck it up" mentality that discourages timely processing of difficult calls.

In 2015, a group of EMS leaders participating in the Fitch and Associates Ambulance Service Manager training program created a survey to characterize the state of the mental health and well-being of EMS providers. The report resulting from the convenience sample, meaning respondents self-selected and opted in to participate, is titled "What's Killing Our Medics?" [1].

The findings from the survey are alarming and demonstrate a far higher incidence of suicidal thoughts and attempts among EMS providers than the U.S. average. In the survey, 37 percent of respondents reported having considered suicide compared to a CDC report of 3.7 percent for the U.S. population. Also, 6.6 percent of survey respondents reported a suicide attempt while 0.5 percent of the U.S. population makes a suicide attempt annually.

The survey also summarizes respondents' views on the effectiveness of mental health resources available to them. A majority of respondents who had previously participated felt that Critical Incident Stress Management, private counseling and employee assistance programs were all effective.

Alarmingly, however, many respondents had not sought assistance because of concerns about notations in their employee file, what their peers would think and not wanting to be identified.

Acute versus cumulative stress
Most EMS providers have been asked by a member of the lay public about "the worst call you’ve ever run" or "the worst thing you've ever seen." Honest versus sugar-coated answers aside, many providers can think of particularly traumatic or upsetting calls without too much difficultly.

These are the types of calls which may produce acute stress for providers. There may be some aspect of the call which is too familiar and makes it uncomfortable (a fatal vehicle collision involving the same make and model of vehicle your wife drives) or the nature of the call may be especially upsetting (child abuse or drunk driving collisions).

These calls are increasingly being recognized by EMS leadership as needing or at least offering an intervention. Even small EMS systems may be able to offer CISM services, peer support team or an employee assistance program in conjunction with surrounding agencies. As mentioned in "What's Killing Our Medics," participants in these programs reported that they found them useful in dealing with stress.

While acute critical stress incidents are better recognized, chronic stress may not be as well perceived. EMS providers are subjected to low levels of stress every time they are on a shift. Driving with lights and sirens, dealing with combative patients, fear for personal safety and compassion fatigue can all add up. Pile on the lack of sleep, long hours and difficult relationships at home and at work and it's easy to see from the outside how a provider can become overwhelmed over time.

While this may be apparent from the outside to the chronically-stressed EMS provider it may all feel routine. There have been reports of several EMS provider suicide deaths to particular acute stress incidents. Many EMS provider suicide deaths are more likely attributed to the build-up of every day stressors.

Stress management techniques
One of the first steps in managing stress is realizing that it is inevitable and is particularly prevalent in our line of work. The nature of EMS requires that providers not become easily overwhelmed while on a call and treating a patient. Over time, providers become adept at compartmentalizing that stress so that they can provide effective care during a call.

This is only the beginning, however. Finding a way to process that compartmentalized stress and finding a healthy release is key to maintaining good mental health. In the "What's Killing Our Medics" report, one third of respondents reported utilizing exercise to cope with stress while another quarter reported talking about stressful incidents.

Exercise and talking are good strategies for dealing with stress, but providers need to work to become aware of when standard coping strategies are ineffective. As reported in the survey, the mental health resources available to you are likely to be effective when used.

Intervening with others
EMS providers may recognize stress in their peers more readily than themselves which begs the question "What do you do about a coworker who is struggling?"

Lending an ear is certainly a great step forward and processing stressful calls in a safe environment (like with your partner) helps manage your cumulative stress. Providers should be comfortable, however, with encouraging their peers to seek additional help if it seems like stress is becoming chronic, is resulting in unhealthy or risky decisions or if a coworkers begins talking about violence or suicide, even if they laugh it off as a joke. If you believe that a coworker is at immediate risk, contact a supervisor.

After checking out the ambulance, you and Jeff go into service. Once you arrive at your post, you mention to Jeff his recent streak of attendance issues and ask if everything is okay.

"Sure," he says. "I guess. I just feel like we aren’t really making a difference out here anymore. That and my school load is pretty overwhelming this quarter so I haven’t been sleeping much."

"Do you have anyone you can talk to?" you ask.

"Yeah I talk a little bit with my roommate, but he doesn't really understand what our job is like."

"Maybe you can see if the supervisor has a number of someone who has experience working with EMS providers or you can contact our employee assistance program directly."

"Yeah I guess, I just don't want people to think any less of me for looking for help; like I can't handle things here."

"I think people would rather you get a good handle on things and keep working here."

"Yeah I guess. I’ll give her a call when we get off tomorrow."

To learn more about stress and the EMS provider, check out the report "What's Killing Our Medics" and the site Reviving Responders developed by the authors of the survey. If you or someone you work with is struggling and in need of resources, The Code Green Campaign may be able to help. Their website has general and EMS-specific mental health and suicide resource links.


  1. Cord, A., Barber, E., Burke, B., Harvey, J., Newland, C., Rose, M., & Young, A. (2015, April 21). What’s Killing Our Medics? Retrieved from http://www.revivingresponders.com/s/Whats-Killing-Our-Medics-Final-ub4v.pdf

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