Trending Topics

Lead from the front lines: Care for our caregivers

How to recognize signs of stress in personnel and offer support during the COVID-19 crisis


EMS leaders set direction, build an inspiring vision and create culture by visibly leading and managing risk from the front lines of the battlefield.

Photo/Getty Images

By Jay Fitch, PhD

The COVID-19 pandemic is challenging EMS and other parts of healthcare systems throughout the world. It’s frequently described as a war. From the caregiver’s perspective, we are losing the battle. EMS caregivers are particularly hard hit, often facing intolerable pressures at both work and home. As leaders, our job is to support our caregivers and other team members. We need to turn fear into courage by our leadership actions. EMS leaders set direction, build an inspiring vision and create culture by visibly leading and managing risk from the front lines of the battlefield.

In aviation, the anachronym PAVE is used to remind pilots of the key elements of risk management. I’ve adapted the concept for EMS to help us remember key tasks as EMS leaders.

  • Process changes during the crisis. Leaders should modify work processes, workflows and personnel schedules to make sure that we optimize the agency’s response capabilities. That includes adapting emergency medical dispatch protocols, and emergency and non-emergency response parameters. Temporarily modifying municipal contract requirements and working with state officials to allow recently retired personnel to re-enter the workforce is another step. It may even mean utilizing non-certified volunteers or wheelchair transport personnel to drive units to otherwise provide relief for the workforce. We have to practice the art of flexibility during this crisis.
  • All needed equipment. Make sure caregivers have personal protective equipment (PPE) and other needed items. Buy, beg, borrow and steal PPE (well, maybe not steal – but aggressively demand prioritization of PPE distribution for EMS caregivers from emergency management and local officials). One provider shared with me that her agency has been rationing PPE. When management left last Friday afternoon, the additional N95s the agency received were locked in the logistics manager’s office and were not available to supervisors for distribution as needed. Leaders – pay attention! Do whatever is required to avoid similar stupid moves by members of management that cause caregivers to feel de-valued.
  • Environment. Limit exposure by changing environmental factors. This includes reducing the number of first responders, law enforcement and EMS personnel entering private homes, nursing homes and other high-risk environments. Changing protocols to prohibit patient family members from riding in the cab of the unit is another example. Dramatically increasing the cleaning of all interior vehicle and station surfaces is recommended.
  • Emotional and external pressures. EMS caregivers and their families are fearful. The emotional toll COVID-19 is taking and will take on the workforce, now and following the crisis, is an under-recognized EMS system failure point. We already know that caregivers are more at risk for suicide than other professions. The risk is higher during COVID-19. As leaders, we must also re-double our efforts to pay attention to those who are going through other major life events including divorce, deaths of family members, children unable to get out of the house, and financial pressures due to the loss of their spouse’s income.

Watch for red flags, signs of stress in caregivers

There are a variety of signs of increasing stress that leaders should watch for among caregivers. They include mood swings, restlessness, irritability, anxiety, anger, resentment, loss of objectivity, memory issues, poor concentration, decreased focus, impaired judgment, a lack of joyfulness or other signs of depression.

Major red flags include talking about suicide, being a burden to others, feeling trapped or having unbearable pain. Act immediately if you notice any warning signs or if another EMS team member comes to you with concerns about a colleague.

What actions should leaders take to mitigate these factors? Empower supervisors by sharing the stress signs listed above. If you’re concerned that someone on your team may be suicidal, start by having a conversation. You might feel unsure about what to say, but the main thing is to be calm and nonjudgmental. You don’t need to solve their problems or understand “why” – just listen and encourage them to seek support or check in with their health professional. Don’t be afraid to ask directly if they are thinking of suicide. Asking the question does not increase the person’s risk, but their response will help you understand how they are feeling. Your role is to provide reassurance and offer support.

Caregivers have a tough job on a good day. COVID-19 has turned good days into nightmarish times for EMS. The best EMS leaders lead from the front lines. In these difficult times, we have to be both accessible (with appropriate social distance) and attentive. Remember, if you can only do one thing to support your caregivers – listen loudly. It will help improve the day for both of you.

About the author

Jay Fitch, PhD, is the founding partner of the EMS/public safety consulting firm Fitch & Associates. He has been an instrument-rated pilot for over 15 years. He serves as the co-chair of the Pinnacle EMS leadership conference and is a founding commissioner of the American College of Paramedic Executives. Contact him at

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