Maintaining Resilience and Mental Health in the EMS Profession

David Bullard

September 26, 2023

The suicide rate among emergency medical service (EMS) professionals rose a shocking 38 percent since 2009, according to a study published in the Western Journal of Emergency Medicine. But as shocking as that statistic is, it should come as no surprise.

As an emergency medical technician (EMT) or paramedic, you typically work a five-day rotation of 12-hour shifts (days or nights). You may start the week working Monday and Tuesday and then have Wednesday and Thursday off. You spend half your first day off catching up on sleep, doing chores, and running errands. You’re free the next day, but pretty much alone because everyone you know is at work or school or busy with other normal weekday obligations. 

EMS professional looking worn down with head in hands

As a result, you likely lack the social connections many of us rely on for emotional support and psychological well-being. Come Friday, Saturday, and Sunday — when your friends and family are off work — you’re back on the job, providing critical medical care in highly stressful situations involving people who don’t always treat you with the respect and appreciation you deserve. And you have to perform this service with a smile on your face, because you don’t want a complaint on your record.

To make matters worse, emergency medical care leaves no room for mistakes. Quality assurance (QA) and quality improvement (QI) programs ensure that Monday morning quarterbacks are always looking over your shoulder to spot mistakes and offer their criticism and sage advice from their comfortable seats along the sidelines.

It’s Getting Worse Instead of Better

Thanks to high healthcare costs and doctor shortages, many people don’t have access to a general practitioner, so guess who they call when they have nowhere else to turn, especially in the event of a mental health emergency? They pick up the phone and dial 911. And those types of emergencies are on the rise. 

Imagine being sent to the same location over and over again — essentially a “cry wolf” scenario — and having to remain on that scene while simultaneously hearing the dispatcher report a child choking in your district. Unfortunately, many of us in the profession don’t have to imagine these situations. We’ve experienced them.

So now, exhausted from your three-day weekend shift, you’re expected to leave everything you’ve seen, heard, and smelled back at the station and not take it home with you. Great advice, but how is that even possible?

What’s the solution? First off, every EMS agency should have a wellness and resilience program that includes a variety of mental health services that focus on both prevention and assistance to help individuals when they’re suffering from mental health or emotional problems.

In addition, we should all be working together to improve the situation for EMS professionals. In the following sections, I offer advice for EMTs and paramedics, their supervisors, and the public.

Self-Care Advice for EMTs and Paramedics

Caring for the health and well-being of others can negatively impact your health in several ways:

  • Irregular working hours can result in poor sleep.
  • Working in transit can result in poor diet and eating habits.
  • The highly emotional work environment can place you at a greater risk of depression, substance abuse, and suicidal thoughts.

Here are a few suggestions for self-care:

  • Adopt a sleep routine to regulate your sleep schedule as much as possible.
  • Pack a healthy lunch and snacks instead of eating out at fast food restaurants and convenience stores. Drink more water and less soda or energy drinks.

When you’re off the clock, focus on physical fitness, hobbies, family time, hanging out with friends — anything that takes you away from that ambulance and emergency department (ED) and puts you in a better frame of mind.

Advice for EMS Supervisors

Money, pizza parties, gifts, and other perks are all great for improving retention and resilience, but nothing is more effective than genuine expressions and demonstrations of appreciation and understanding. Acknowledge your employees regularly and spend time with them. Be generous with kudos and frugal with public criticism, and look for ways to make their jobs easier.

One of the things I did as a chief was work Christmas Eve and Christmas Day for two of my employees. I had older children at the time, and I enjoyed filling in for younger staffers so they could be with their children on the holidays. It cost my department nothing because I was a salaried employee; it helped me stay engaged with my field staff; it earned me respect for being back in the trenches; and it kept my finger on the pulse of my community. Eventually, my chief made me discontinue this practice because he felt that it made the other administrators look bad for not doing it. That’s one way to kill morale.

Administrators should visit where they were when they started in order to experience how conditions have change from those we experienced even 10 years ago. I strongly recommend occasionally working alongside your staff during holidays or whenever staffing is low. It’s a great way to build camaraderie, boost morale, earn respect, and keep abreast of changes in the field.

Finally, to all you administrators out there, if you’re sending your shift employees text or email messages reminding them to put their job behind them on their days off, stop it. That’s just another way of constantly putting their job in front of them. Respect their time off. It may be the only thing keeping them there!

Advice for the Public

Our society is experiencing a healthcare crisis, especially in relation to mental healthcare. We don’t have the space and resources to handle the overwhelming demand right now. People can’t get in to see a doctor, or they can’t afford it, so they call 911 for transport to the ED for healthcare issues that could be handled by a general practitioner or a psychiatrist or psychiatric nurse practitioner. EMS providers across the country are overrun with these types of calls, which impairs their ability to respond to life-threatening emergencies.

You can help to conserve ambulatory resources for true emergencies by calling 911 only when necessary. Those instances include the following:

  • The person’s condition appears to be life-threatening — for example, the person is unconscious, bleeding profusely, choking, not breathing, or experiencing a severe allergic reaction.
  • The person’s condition may become life-threatening on the way to the hospital.
  • Moving the person could cause further harm or injury.
  • The person needs the skills or equipment used by paramedics or EMTs.
  • Driving would cause significant delay getting to the hospital.

In all other cases, call your primary care physician or head to an immediate care facility. If needed, contact a friend, neighbor, or family member for a ride.

If you must call 911, be respectful and appreciative of the EMS personnel who show up to help you. Stay out of their way, answer their questions, and do what they tell you to do. Let them do their jobs.

Keep in mind that we need to use our available emergency resources wisely to ensure that everyone has the services during their time of need, and this includes our most valuable resources of all — our highly skilled human resources. Working together in an atmosphere of mutual respect and appreciation is the best way to ensure that our EMS professionals have the emotional support they need to stay healthy and perform their best to preserve and protect our health and safety.

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About the Author: David Bullard is the Director of Emergency Medicine Education at The National Center for Outdoor & Adventure Education (NCOAE) in Wilmington, North Carolina.

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