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Self-care is critical for managing stress levels in EMTs and paramedics responding to COVID-19

Look for these signs of physical and mental stress, and follow these action steps to maintain emotional wellbeing


McLaren Bay Region paramedic Kirk Andrzejewski demonstrates common practices with the new masks they will be wearing to prevent the spread of coronavirus in Bay City on Tuesday, March 17, 2020. They will be wearing gloves, a gown and the masks while on duty.


The world looks a little different today vs. just a week ago. Citizens of towns, cities and counties across the country are being asked to isolate themselves in a concerted effort to stop the spread of a potentially deadly disease caused by a pathogenic virus. EMTs and paramedics are frontline warriors in the war against COVID-19.

EMS agencies throughout the country are working with their state and local public health agencies and healthcare systems. They’re adapting protocols and procedures according to the evolving CDC guidelines as well as preplanned pandemic response guidelines. It’s a war they’ve trained for, and they’re answering the call – from working overtime to following strict PPE, infection control and documentation guidelines.

Despite their training and being prepared, there are always high levels of stress and uncertainty in major incidents such as this pandemic. EMTs and paramedics must recognize and accept that they will likely encounter increased levels of stress as this pandemic evolves.

Recognizing stress and coping with it appropriately is sometimes forgotten in a crisis, but it’s crucial to gauge your mental health and emotional wellbeing so that your stress levels are manageable and allow you to best help your community.

Signs of physical, emotional and mental stress to look out for include:

  • Physical signs. Rapid heart rate, palpitations, muscle tension, headaches, tremors, gastrointestinal distress, nausea, inability to relax when off duty, trouble falling asleep or staying asleep, excessive tiredness.
  • Excessive negative feelings or social conflict. Anger, frustration, combativeness, irritability, deep sadness, blaming others, conflicts with your partner or colleagues, arguments with family and friends, difficulty maintaining emotional balance, isolation or disconnection from others.
  • Compassion fatigue. All caregivers can reach a limit in their ability to provide care and empathy. Recognize the signs of compassion fatigue and inform your supervisor, especially if you feel there could be a negative impact on your mental health or your ability to provide patient care.
  • Cognitive difficulties or confusion. Difficulty thinking or recalling instructions, disorientation, difficulty problem-solving, remembering instructions or making decisions, inability to see situations clearly, distortion and misinterpretation of comments and events.
  • Problematic behavior. Unnecessary risk-taking, failure to use PPE, poor self-hygiene, refusal to follow orders or leave a scene.

Sometimes these signs are easier to spot in others and you might not see them in yourself. It’s important that you talk to your partner, colleagues and supervisors if you recognize any of these signs in yourself or others. Remember that you depend on one another for support.

Should a colleague express concern regarding your behavior, be grateful they spoke up and carefully think through their feedback. You must be able to look at yourself critically and adjust your behavior or inform your supervisor if you’re overwhelmed. This is an important responsibility, not just for yourself, but also your colleagues, friends, family and community.

The COVID-19 pandemic may make some aspects of self-care more challenging, but it’s more important than ever to consider these basic self-care techniques during times of heightened stress. Each has a wealth of evidence to support their value in maintaining emotional wellbeing:

  • Process your experiences and stressors during the pandemic. This can be done alone by writing in a journal or you can talk with a partner, colleague, friend or family member. Discuss your reactions and emotions, as appropriate.
  • Maintain proper nutrition and get plenty of rest.
  • Reduce physical tension through exercise and activities. Breathing and relaxation techniques are also beneficial.
  • Allow yourself a break from the pandemic by turning off the news and limiting media coverage – spend quality time with friends and family, read a book, watch a movie or listen to some music.
  • Limit your caffeine and alcohol intake, and do not overuse medications or turn to medication or drugs to reduce stress.
  • Remind yourself that working all the time does not mean you are making your best contribution.

Communication is critical in times of disaster response and can help maintain manageable stress levels. Although your agency will likely conduct regular briefings in an effort to update staff on the pandemic and any hazards or changes in procedures, if you feel you need more information or assistance, it’s your responsibility to ask for it. Err on the side of caution, especially if it comes to PPE and infection control. Communicate regularly with your partner, coworkers and your supervisor.

Finally, and of critical importance: Ask for help if you feel overwhelmed or if you have any concerns that COVID-19 is affecting your ability to care for yourself, your family or for patients. If you don’t feel comfortable speaking with a supervisor, access your department or agency’s employee assistance program or any other caregiver support services offered by your agency.

Read next: Protecting the mental health of first responders during a pandemic


Ryan Kelley, NREMT, is a nationally registered emergency medical technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). In his current capacity as medical editor for American Addiction Centers, Ryan works to provide accurate, authoritative information to those seeking help for substance abuse and behavioral health issues.