Fall 2022
The Relationship between Stress & EMS Providers
Wesley Sykes


About 30 percent of first responders develop mental health disorders, including depression, Acute Stress Disorder (ASD), and post-traumatic stress disorder (PTSD), as compared with 20 percent in the general population, according to a 2015 study entitled, ‘What’s killing our medics? Ambulance Service Manager Program.’ 

Another common occupational risk factor includes acute and chronic exposure to both primary and secondary trauma, the latter referring to the phenomenon of emotional and moral attachment to the experience of the individuals they rescue.  

These overwhelming demands from first responders can lead to compassion fatigue, a depleted capacity for empathy that results in various behavioral issues including depression and anxiety. Burnout is a similar phenomenon of exhaustion resulting from occupational strain such as overwork and lack of support from leadership. These conditions have been found to directly contribute to the more than doubled suicide rates among medics than other professionals, according to a 2019 study entitled, ‘Death by suicide-The EMS profession compared to the general public.’

In addition to the risks of repeated trauma exposure, EMS providers are expected to be on duty for up to 24 hours at a time and can experience trauma and/or violence while on shift. In fact, 69 percent of EMS providers report never having had enough time to recover between traumatic events, as cited in the 2013 study, ‘An assessment of depression, anxiety, and stress among nationally certified EMS professionals.’ The length of shifts, poor sleeping conditions while on-call, and prolonged night shifts all disrupt sleep patterns, which could contribute to the possible development of burnout and eventually even depression or substance use disorder.  

In addition to PTSD, depression, and other mental health conditions, EMS personnel also experience higher rates of problematic alcohol and drug use than the general population. In a 2017 published study, Haddock et al. reported that women first responders had rates of smoking, alcohol, and other drugs that were three times that of the general population. Many paramedics also have access to substances that carry the potential for abuse.  

Mental health disorders frequently co-occur with other disorders, including substance use, in the EMS workforce, and treatment for these concerns is vital to improving quality of life, as cited by the 2017 study entitled, ‘Describing the mental health profile of first responders.’ Yet, EMS workers are often reluctant to seek care to avoid disciplinary action, stigma, and other “codes of silence” that prevent peers from reporting any behavior that may alert leadership to the presence of mental health or substance use issues.

There are multiple strategies that recognize and want to act on mental health and substance disorders. Treatment for both conditions often includes counseling, group therapy, and medications. An often underutilized and underrated resource is the range of local peer recovery organizations. Recovery centers are aware of local treatment, group meetings, and many other resources. It is also important to focus on personal health and hygiene strategies: getting a good night’s sleep, finding alternative outlets outside of work, developing new hobbies, exercising daily, and eating right.  

» ALSO SEE: Physical Impact of Stress on Tactical Athletes

For those who need help or individuals who may be concerned about their loved ones or peers’ behavior, there are a number of excellent, confidential resources, including Substance Abuse & Mental Health Services (SAMHSA) www.findtreatment.gov site that can help identify local treatment resources.   

Recognizing the signs and symptoms of these disorders is essential, but even more imperative is taking the next step and seeking help. 

Information from this article was sourced from the Journal of Emergency Medical Services