In this episode of EMS One-Stop, Rob Lawrence sits down with Dr. Maria Koeppel to explore a topic that has long existed in the shadows of EMS culture — alcohol use among providers.
| MORE: First responders and alcohol – how much is too much?
Drawing on NIH and FEMA supported research, Koeppel outlines how EMS clinicians may be engaging in higher-risk drinking behaviors than the general population, with patterns influenced by stress, exposure and workplace culture.
What emerges is not a story of individual weakness, but one of systemic pressure — where both major traumatic incidents and the accumulation of low-acuity, high-frequency calls contribute to a steady burden of stress that many providers attempt to manage off-duty.
The conversation moves beyond statistics into culture, leadership and generational change. Koeppel highlights how traditional “crew bonding” through alcohol — what one participant termed “hydraulic debriefing” — may be giving way to a new, more wellness-focused approach among younger clinicians.
At the same time, gaps in education, policy and peer support remain evident across EMS systems. For leaders, the message is clear: alcohol use is not a fringe issue, but a workforce health, safety and performance issue that requires thoughtful engagement, cultural awareness and proactive support structures.
Key quotes from Maria Koeppel
- “Over 50% of firefighters surveyed had binge drank in the last 30 days — about twice the rate of the general population.”
- “EMS providers tend to drink a little bit more frequently than the general population — and that’s tied directly to stress.”
- “It’s not just the big trauma calls — it’s the micro-stressors that add up over time.”
- “A third of clinicians in our sample engaged in high-risk drinking behaviors.”
- “Younger clinicians are at higher risk — but that risk declines with age as coping mechanisms develop.”
- “Paramedics are at higher risk than EMTs, likely due to increased responsibility and patient exposure.”
- “Some described going out after shift as ‘hydraulic debriefing’ — using alcohol to process the day.”
- “Gen Z is driving a more sober culture — they’re choosing connection without alcohol.”
- “Leadership isn’t just policy — it’s culture, awareness and how you care for your people.”
- “Alcohol and coping has to be part of the conversation if we care about workforce health and patient safety.”
Episode timeline
01:06 – Maria’s background: firefighter and researcher
02:24 – Overview of NIH/FEMA research and EMS focus
04:14 – Key findings: stress, frequency of drinking and EMS culture
05:08 – Micro-stressors vs. major trauma calls
06:54 – Risk factors: age, role, education, multiple jobs
10:11 – Culture and “hydraulic debriefing”
11:46 – Fire vs. private EMS cultural differences
14:38 – Generational shift: Gen Z and sober culture
19:24 – Alternative substances and coping trends
21:20 – Leadership roles: policy vs. culture
24:11 – Peer support gaps in EMS
26:41 – Workforce impact: sleep, stress, retention
27:14 – Education gap and need for EMS-specific training
29:11 – Conferences and future research dissemination
30:13 – Episode wrap-up
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