How EMS providers can manage chronic stress

Over the past few years, there has been more awareness about PTSD and its effect on EMS providers

By Amy Eisenhauer, student, Political Science at American Public University

Stress is not always “bad” for us — it can assist in some everyday functions and be particularly beneficial for first responders. The human brain is designed to use stress to tell us when to respond to something that could be potentially harmful or threatening. After responding, we can then deal with the incident and learn from it.

For first responders, stress occurs most often when responding to incidents and providing emergency medical care in some of the most dire circumstances. This type of short-term, moderate stress can actually be good for us as it encourages stem cell development that then grows into new brain cells, followed by improvement in learning and memory.

EMS providers continue to face multiple sources of stress on a daily basis and more must be done to acknowledge and address these stressors in a healthy way.
EMS providers continue to face multiple sources of stress on a daily basis and more must be done to acknowledge and address these stressors in a healthy way. (Photo/AMU)

However, the problem occurs when stress becomes chronic, intense, or both, which can occur in the day-to-day activities of an EMS provider. Chronic and intense stress stunts stem-cell growth in our brains during the stress response, which can lead to limited new brain cell development.

Stress can also negatively impact EMS providers by causing an increased risk for cardiovascular disease, suppression of the immune system, reduction in fertility, higher-risk of miscarriage, and, most prominently, stress can lead to post-traumatic stress disorder (PTSD).

Over the past few years, there has been more awareness about PTSD and its effect on EMS providers. Thanks to awareness campaigns, educational outreach, and focused efforts to erode the stigma of asking for help, the EMS profession has made big strides in acknowledging mental health injuries.

However, EMS providers continue to face multiple sources of stress on a daily basis and more must be done to acknowledge and address these stressors in a healthy way. Some of these chronic and potentially overwhelming stressors include:

Cumulative Incident Stress:

This is related to the imperceptible accumulation of traumas related to EMS response over time, whether witnessed or experienced. These can include witnessing the results of violence or injury on a continual basis. In addition to responding to tragedy like car accidents and medical emergencies, EMTs often respond to gang violence, domestic violence, or cases of child abuse. They can also experience abuse themselves, whether physical or verbal, from patients, patients’ family members, or bystanders.

Critical Incident Stress: 

A critical incident is any event that has a stressful impact severe enough to disrupt an individual’s normal coping skills. These incidents are abrupt and powerful and fall far outside the range of the average human experience. Examples of critical incidents for EMS providers include, but are not limited to: responding to an incident involving family or friends, traumatic incidents with extensive or extreme injuries, mass casualty or mass fatality incidents, or incidents involving the grave injury or death of children.

Organizational Stress: 

Typically, organizational stress is defined as stress related to one’s job. Due to the multitude of stressors found in EMS, organizational stress in EMS agencies is specifically related to in-house issues such as poor leadership, limited or no planning of projects, insufficient planning for daily shift needs, lack of support for providers, limiting or bad policies, or professional stagnancy and no opportunities for professional growth. The most prominent complaints related to organizational stress include long hours, poor interaction between co-workers, and low pay. These stressors can lead to poor job performance, high staff turnover, mistrust of leadership, burnout, and ultimately increased organizational stress for the EMS providers who remain.

Personal Stress: 

This is stress related to a provider’s life outside work. These stressors can include family problems such as marital issues, sick children or parents, or the provider’s own health problems. Stressors can also be related to financial needs due to low wages and the necessity of managing multiple work schedules with additional responsibilities.

Poor Sleep Hygiene: 

Poor sleep hygiene can be related to working too many hours in a row, not planning appropriate rest times when not at work, using alternative methods to fall asleep like sleep aids or alcohol, or even “listening” for the radio while resting on a long shift at work. The brain uses sleep as a tool to organize memories, recuperate, and recharge itself, which benefits both mental and physical well-being. The lack of sleep or poor sleep habits can exacerbate even normal levels of stress.

Providing Services to Help Manage Stress

Stress can work to our benefit, but only when we manage it properly. Historically, agencies have offered critical incident stress management (CISM) programs and chaplain services following a critical incident. These are excellent services, but there are many other available tools that can benefit EMS providers in tandem with these more traditional services.

For example, resilience training during initial and continuing education courses, first responder specific employee assistance plans (EAP), and peer-support teams can help providers address stressors in a healthy manner before they accumulate and cause severe problems. Alternative stress relief such as first responder-specific yoga can address both stress and physical fitness. Of course, if stress levels are excessive and are, leading to, or already requiring, the help of a mental health clinician, there are multiple outpatient and in-patient therapy programs tailored for the specific needs and experiences of first responders.

EMS providers can experience events that lead to all the types of stress listed above and more during a typical shift. It is up to both the provider and agency leadership to be aware of these stressors and have the tools necessary to help mitigate and limit these stressors before they reach unhealthy levels that can affect both work performance and personal relationships.

If you, or another EMS provider, need help, don’t be afraid to ask for it. If your agency doesn’t offer any mental-health or stress-relief services, ask for a referral to access them in your region.

If you don’t have anyone you can speak to or trust, call Safe Call Now, a first responder-specific crisis line that is available 24 hours a day at (206) 459-3020. We are our brother’s and sister’s keepers, not just on the street, but at our stations as well. If you recognize signs of stress in your fellow provider, don’t delay in getting them help, it could save their life.

About the author: 
Amy Eisenhauer is currently studying Political Science at American Public University. She is a dynamic presenter at EMS conferences nationwide, raising awareness on topics such as provider suicide, response to hoarding events, and career development for EMS professionals. As a certified EMT, she has served the New Jersey Emergency Medical Services community as a volunteer and career provider since 1995. In addition to providing high-quality medical care, Eisenhauer has taken on challenging roles as an EMS educator and training officer. She also hosts an interactive blog, To contact the author, please send an email to

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