Emergency medical services (EMS) workers report to the scenes of accidents and medical emergencies, administering urgent aid and life-saving measures. Consisting of emergency medical responders, emergency medical technicians, (EMTs), advanced EMTs, and paramedics, these first responders selflessly dedicate their lives to maintaining public health and safety. However, this often comes at the expense of their own mental health.
EMS workers are repeatedly exposed to events involving injury, violence, death, and grief. Throughout the course of their careers, EMS workers come face-to-face with an endless list of worst-case scenarios. When experienced repeatedly, these high-stakes situations can cause chronic stress, compassion fatigue, and burnout, as well as mental health conditions like post-traumatic stress disorder (PTSD), substance use disorder (SUD), anxiety, depression, and suicidal tendencies.
Witnessing and experiencing trauma can deteriorate mental health, especially without the proper support. People who are accustomed to providing help are sometimes the last people to ask for it, even when getting help is critical. However, many treatment options exist today to help EMS professionals or anyone dealing with the effects of trauma and chronic stress regain their mental health.
Mental Health Conditions In EMTs And Paramedics
The nature of their jobs, which involve life-and-death decision-making and repeated exposure to human pain and suffering, coupled with long hours, overwhelming workloads, and inconsistent sleep, is mostly to blame for EMS workers’ mental health struggles. These professionals are asked to “expect the unexpected,” being prepared at all times to enter the most unpredictable and chaotic scenes.
According to a study published in Social Psychiatry and Psychiatric Epidemiology, 27% of first responders suffer general psychological distress, 15% have anxiety, 15% have depression, and 11% have PTSD. Prehospital Emergency Care reports that suicide rates among EMS workers (5.2%) is more than double the general population (2.2%). PTSD, substance use disorder (SUD), and suicide in EMS workers is discussed more below.
Post-Traumatic Stress Disorder (PTSD)
PTSD is a trauma disorder, or one that occurs after a person experiences or witnesses a distressful, disturbing, or life-threatening event and has difficulty recovering from it. People with PTSD have triggers that may cause flashbacks, nightmares, intense reactions, severe anxiety, and more.
More than 80% of first responders experience traumatic events at work, according to ScienceDirect. And about 33% of first responders will develop PTSD compared to 20% of the general population, the Substance Abuse and Mental Health Services Administration (SAMHSA) reports. Symptoms of PTSD can interfere with EMS workers’ ability to perform their job correctly and affect their quality of life outside the workplace. It can also segue into other mental health issues, like anxiety or depression, substance abuse, and suicide.
Substance Use Disorder (SUD)
The ongoing daily stressors that EMS workers face make them more vulnerable to developing a SUD, thus the relationship between EMS and addiction risks are high. After administering care in emergency situations, some EMS workers may use drugs or alcohol to cope.
The pathway to addiction may not be linear for many EMS workers. For example, it’s common for these workers to congregate at bars after work for camaraderie and to “wind down” from a difficult shift. In fact, it’s a part of the established social scene among these workers. However, frequent exposure to alcohol can quickly lead to binge drinking behaviors and more frequent drinking and eventually segue into addiction.
It’s difficult to determine the exact number of EMS workers who use drugs or alcohol. Many studies on addiction and first responders group EMS workers together with firefighters, police officers, and others. A report published by the Association for Addiction Professionals (NAADAC) estimated that between 16% and 44% of first responders engage in heavy drinking. The statistics surrounding drug use are unknown, but they are presumed to be within this range as well.
Suicide
Frequent exposure to trauma, heavy workloads, and the effects of PTSD or SUD, if applicable, all contribute to high rates of anxiety and depression in EMS workers. Further, the 2023 EMS Trend Report, a review that has reported on the EMS field and related concerns for the last eight years, surveyed 3,100 EMS workers that year and found that more than 80% experienced moderate job stress and an additional 11% consider their stress level “extreme.” Of these respondents, more than half said that stress is causing debilitating effects on their health.
All these factors play a role in the high risk of suicide among EMS workers. According to a study published by Prehospital Emergency Care that evaluated 350,998 deaths among EMTs, specifically, between 2009 and 2015, 5.2% of these workers died by suicide; more than double that of the general population (2.2%). Journal of Safety Research reports that between 2015 and 2017, first responders made up 1% of all suicides in the U.S. Among first responders, EMS providers make up 18% of suicides.
Contributing Factors To Poor Mental Health In EMS Workers
Some of the factors that contribute to the high rates of PTSD, SUD, and suicide among EMS workers are mentioned above, including repeated exposure to trauma, demanding workloads, long hours, and high stress. However, there are additional issues worthy of mention that influence the high rates of mental illness and SUD in EMS workers, including compassion fatigue and reluctance to seek professional help.
Compassion Fatigue
Compassion fatigue is a phenomenon that occurs when a person becomes emotionally affected by the demands and stress of caring for another person or persons. Also known as secondary traumatic stress or “the cost of caring,” compassion fatigue is when someone takes on the mental weight of another person’s trauma, suffering, and/or psychological pain. It is the result of blurred boundaries and caregiver burden, and can affect the ability to provide care in the future.
In a study of 686 EMS workers published in Prehospital Emergency Care, nearly half (48%) had compassion fatigue. Of those with compassion fatigue, 8.6% of respondents were in therapy and nearly one third (33.1%) had contemplated suicide. EMS workers were also 48% more likely to have compassion fatigue if they knew an EMS worker who committeed suicide.
Burnout
Job burnout refers to total mental, emotional, physical, and spiritual exhaustion as related to one’s occupation. Although burnout is not a medical diagnosis, it can segue into a myriad of psychical and psychological problems. According to the National Association of EMS Physicians, burnout can contribute to mental health disorders and physical conditions including heart disease, gastrointestinal complications, and a weakened immune system. Because burnout can affect a person’s ability to perform their job well and consistently, it is also linked to a higher rate of absenteeism and turnover. Additional symptoms include depersonalization, and feelings of helplessness and powerlessness.
Reluctance To Seek Professional Help
The EMS field often involves an adrenaline-fueled work environment. There is a stigma about seeking help, with workers often expected to “tough it out,” brought on by the need to be calm, composed, and seemingly fearless. This stigma is referred to as the “code of silence.” Some EMS workers are concerned that admitting to mental health struggles will put their job in jeopardy, or cause them to seem less capable than their colleagues. It’s an ironic notion, considering it’s their responsibility to ensure the care of the general public, which includes people who are in mental health crises themselves. Unfortunately, the social acceptance of not admitting to needing help continues to have negative effects on EMS workers.
Signs Of Mental Health Issues In EMS Workers
If an EMS worker is experiencing an impending mental health crisis, there may be telltale signs. These signs may include physical and/or psychological symptoms, and changes in overall personality and demeanor.
Signs of mental issues in EMS workers include:
- anxiety
- changes in mood, e.g., anger, sadness, irritability, indifference, etc.
- difficulty managing stress levels
- dissociation
- drug use
- feelings of helplessness and/or overwhelm
- increased alcohol consumption
- physical ailments, e.g., stomach upset, headaches, nausea, vomiting, etc.
- self-care neglect
- social isolation
- sleep disturbances
Breaking The Stigma: Encouraging EMS Workers To Seek Help
Seeking help for mental health issues can provide a myriad of benefits for those who need it. When going to therapy, even the act of merely talking openly to a trusted adult can feel like a release. Meeting with a licensed professional can help with processing trauma, both from the past and as new events occur in the EMS field. These professionals may also be able to determine whether mental health medication is needed to provide additional support. Without these avenues, however, EMS workers may continue to suffer in silence.
One of the more effective ways to break the stigma is for companies and employers to destigmatize the need for mental health support. Those in managerial positions may consider providing EMS workers with supportive resources such as contact information for counselors, therapists, and psychiatrists as well as peer support groups. A workplace culture that encourages openly talking about difficult experiences and feelings can also help to diminish any stigma.
Bedrock’s Frontline Pathway To Recovery Program
EMS workers routinely come into direct contact with destruction, chaos, and death and are responsible for managing each situation with thoughtful consideration, calmness, and clarity. The good news is that EMS workers do not have to cope with the emotional weight of these experiences alone.
Programs like BRC’s Frontline Pathway to Recovery provide tailored, evidence-based treatment options for first responders, promoting safety, empowerment, and education. Our multidisciplinary approach can help EMS workers and other first responders find lasting recovery from substance use and co-occurring mental health issues.
Available treatment services include:
- medical drug or alcohol detox
- medication management
- behavioral therapy, such as CBT
- psychotherapy, or “talk therapy”
- group therapy
- family psychoeducation
- peer support
- medication-assisted treatment (MAT) for opioid or alcohol use disorder
- expressive therapies, such as art, music, and sound/tone therapy
- massage therapy
- wellness activities, such as yoga
- case management
- aftercare planning
- alumni program
Call Bedrock Recovery Center To Learn More
If you or a loved one works in the EMS field and is ready to receive help for mental health issues and/or substance abuse, contact Bedrock Recovery Center today to learn more.
