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Breaking the culture of silence

“Most likely, you know at least one caregiver who is struggling, but you’re reluctant to act”

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By Jay Fitch, PhD

There is a culture of silence surrounding mental health in the EMS/public safety profession. The stigma surrounding mental health for EMTs, medics, firefighters, supervisors and others is a major barrier to disclosure. Caregivers fear losing their professional identity and livelihood, and facing discrimination if they come forward. The pandemic exacerbated the mental health challenges faced by public safety team members. Staff shortages, mandatory overtime and less opportunity for training have all contributed to increased stress and anxiety.

Most likely, you know at least one caregiver who is struggling, but you’re reluctant to act. You may not know how to approach the subject, what to say without offending your coworker or emphasizing their difficulty, or whether you can make a difference. Hesitating out of fear or uncertainty can drastically affect an individual and the entire team and add to the growing EMS mental health crisis.

An alarming number of caregivers have considered leaving the profession because of compassion fatigue, according to recent studies. As members of a collaborative, compassionate field, EMS/public safety professionals must first learn to recognize problems and care for themselves and their colleagues, so they can care for patients.

How one caregiver’s struggle can impact the entire system

Well-being struggles, such as compassion fatigue, burnout and depression, are never neatly confined to a single team member. Rather, they affect each caregiver, which alters the service’s emotional, mental and practical climate, shaping and influencing every process with a negative ripple effect. Common examples include:

  • Decreased morale. Negative thinking, irritability and emotional outbursts can hurt other team members, create tension and affect performance. Such behaviors can also be contagious and create a negative organizational culture and a vicious cycle of apathy and low morale.
  • Increased turnover. Quitting may be the healthiest choice for some individuals, but can inspire others to leave, especially if the departing employee is well-liked or the team’s anchor.
  • Increased workload for others. If struggling team members are apathetic about their work and reduce their performance or call out, their colleagues are forced to take on the extra burden or work more, which can create workplace hostility.
  • Decreased performance may jeopardize patient or team safety. Team members who feel hopeless, fatigued or emotionally detached from their work may unintentionally compromise outcomes and service quality.

Compassion fatigue vs. burnout vs. depression

The most common EMS mental well-being challenges fall into three separate, often misunderstood, conditions. Attributing a caregiver’s struggle to the wrong condition is more than a matter of semantics – leadership may fail to address the affected team member’s problem and therefore fail to target an appropriate resolution.

  • Compassion fatigue. Compassion fatigue stems from the deeply empathetic relationship that EMS professionals have with their patients. When a person’s empathy is exhausted by persistent loss, trauma and ethical dilemmas, they become emotionally detached from their work.
  • Burnout. Burnout results from workplace pressure and stressors, such as conflict, scheduling or compensation issues, call load or a lack of professional culture. In short, burnout is directly related to the work environment, not the work itself.
  • Depression. Unlike compassion fatigue and burnout, which are the consequences of external circumstances, depression is classified as a true mental health concern. Depression can coincide with or be secondary to burnout or compassion fatigue and can be severe and lead to suicidal ideation, so professional help is recommended.

Supporting your team’s well-being is a win-win

Fortunately, recognizing and aiding a struggling caregiver – or having systems in place to do so – can create a system-wide cultural shift that benefits the entire team. Building and fostering a supportive work environment that welcomes constructive feedback, prioritizes well-being, and emphasizes open and honest communication – between leadership and each shift and among peers – means struggling caregivers can not only seek help but also reap benefits of improved performance and the system retaining employees.

Identify and aid team members facing depression, burnout or compassion fatigue to foster an emotionally safe organizational environment

About the author
Jay Fitch, PhD, is a founding partner at the emergency services consulting firm, Fitch & Associates. He has nearly five decades of EMS/public safety experience and now serves as the executive director of the non-profit Fitch EMS Education Foundation.

For more than three decades, the Fitch & Associates team of consultants has provided customized solutions to the complex challenges faced by public safety organizations of all types and sizes. From system design and competitive procurements to technology upgrades and comprehensive consulting services, Fitch & Associates helps communities ensure their emergency services are both effective and sustainable. For ideas to help your agency improve performance in the face of rising costs, call 888-431-2600 or visit