Maintaining Resilience and Mental Health in the EMS Profession

By David Bullard September 26, 2023

Emergency Medicine

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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Opinion: There’s Nothing “Basic” About an EMT

By Kate Javes February 20, 2023

Emergency Medicine

It’s been more than a decade since the National Registry of Emergency Medical Technicians (NREMT) stopped using the certification designations EMT-B and EMT-Basic. 

The change from EMT-B to EMT was not just in title. It was accompanied by an expanded set of knowledge and skill expectations for emergency medical technicians (EMTs). There is nothing “basic” about what an EMT learns or the skills he or she can perform. And they’re certainly not “Ambulance Drivers.”

(Photo Credit: RODNAE Productions | Sourced from Pexels)

Most states have made the transition to the new title, but many emergency medical service (EMS) providers continue to refer to some EMTs as “Basics.” Maybe it’s out of ignorance, or just an antiquated habit, but we need that to stop. It’s much more than just an inaccurate designation — it’s misleading to the public and gives the wrong impression regarding care and capabilities.

Looking Back at EMT Designations

The early terminology came from a haphazard system of state-by-state naming conventions. The NREMT itself started out with an “EMT-Ambulance” or “EMT-A,” later adding an “EMT-Non-Ambulance” designation. As a result of this confusing (more…)

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8 Alternative Jobs to Pursue with an EMT Certification

By NCOAE Headquarters October 14, 2022

EMT Training

Just obtaining an Emergency Medical Technician (EMT) license opens a world of career possibilities both inside and out of the medical field. Sure, you have to put in the effort, but the opportunities are as diverse as our EMT students here at The National Center for Outdoor & Adventure Education (NCOAE).

Fact is, we receive applications from students from all walks and stages of life, who successfully complete our EMT training program and go on to use that EMT training for a variety of opportunities. Some become full- or part-time EMTs, others use this outstanding training and education as a steppingstone for medical or nursing school. And then there are the outdoor enthusiasts who use this EMT training to become Ski Patrollers or members of Search and Rescue crews, or to add an additional layer of medical expertise when guiding groups on mountaineering and backcountry expeditions.

Maybe you’ve been an EMT for a while and are looking for a change, Or maybe you’re thinking about obtaining your EMT certification and then consider your options. While the most popular career trajectory for EMTs is to become a Paramedic, there are a number of jobs that you can obtain with just an EMT certification, keeping mind that some may require additional training. 

Here are eight such opportunities: (more…)

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Most EMS Terminology Comes Down to Initials, Abbreviations and Acronyms

By NCOAE Headquarters August 12, 2022

EMT Training

A few years ago, we ran a three-part series on slogans, slang, and terminology as it applies to a trio of human-powered outdoor recreational activities. If you recall, we started out with some “gnarly” surfing terms, then we “tied in” to a conversation about climbing, finally pulling a “wet exit” on the language of paddling.

You can review these three articles using the links below: 

There was quite a bit of word whimsy in those articles, and we made sure to remind readers that successfully lassoing the linguistics of a particular activity was no guarantee you were mastering that particular sport professionally. 

Today we’re taking a more serious look at language, this time highlighting the terminology used by members of the Emergency Medical Service (EMS) community. That’s because one of our areas of focus here at The National Center for Outdoor & Adventure Education (NCOAE) is emergency medicine training and education. And whether you’re an EMS, medical professional, or wilderness first responder (WFR), these terms are most often employed when these professionals find themselves managing a medical emergency. 

First off, you might notice that most of these terms come in the form of acronyms, abbreviations, and initials, and the reason for that is to enable first responders to quickly communicate and react with each other and the patient in the field.

The source for these acronyms comes from the NCOAE Wilderness Medicine Field Guide (ISBN 978-0-578-87449-4). 

Here, we present them in alphabetical order: (more…)

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NCOAE’s EMT Training Opens the Doors to Jobs Across the U.S.

By NCOAE Headquarters May 25, 2022

EMT Training

Applicants to our nationally renowned EMT training courses often ask us if they can take
their new EMT credentials to the state where they live, and the answer is mostly yes.
The National Center for Outdoor and Adventure Education’s (NCOAE) campus is
located in North Carolina, where we offer 21-day “Intensive” EMT-Basic and 23-day
“Intensive” Advanced EMT training courses among others. Successful completion of
these courses authorize our graduates to take the National Registry of Emergency
Medical Technicians
(NREMT) exam.

National Registry Certification examinations evaluate the competence of EMS
practitioners at a variety of levels, including Emergency Medical Responder (EMR),
Emergency Medical Technician (EMT), Advanced Emergency Medical Technician
(AEMT), and Paramedic.

NREMT credentials are either required for an initial license or accepted for legal
recognition or reciprocity in all 50 states and Puerto Rico. That makes it easier to

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Exactly What Is It That an EMT Does?

By Kate Javes November 14, 2021

EMT Training

Depending on where you live, you may see them every day or just when there’s a fire, police, or medical emergency where you are. Regardless of the frequency with which you see them, you may be wondering — what exactly does an EMT (Emergency Medical Technician) do?

EMTs are not just “ambulance drivers,” although that’s certainly a critical part of their occupation. An Emergency Medical Technician is a trained and certified medical provider who has demonstrated competency in basic pre-hospital medical care.

EMT Trainees

For EMTs and patients, an ambulance is more than transportation to the hospital. It’s a mobile mini-medical center squeezed into the back of a moving vehicle where a skilled team of pre-hospital healthcare providers perform a variety of life-saving medical interventions that save lives every day in every community.

What an EMT Must Learn

While nearly anyone can attempt to become an EMT, in order to qualify to take and pass the National Registry of Emergency Medical Technicians certification exam, candidates must first complete an approved EMS education program. In that program, EMT candidates’ study and learn a lot of things, including:

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How to Become an EMT

By NCOAE Headquarters March 9, 2021

EMT Training

You’re thinking about becoming an EMT. Awesome! If you follow through, you will be joining the ranks of today’s modern-day heroes, the frontline of the frontline workers — bona fide life savers!

Emergency Medical Technicians (EMTs) are trained professionals who provide care in critical and emergency situations. Such emergencies can range from simple, routine calls to intense and complex scenarios.  

You may show up for a call only to discover that there is no victim, or the person is okay and refuses help, or a patient simply needs transportation from one medical facility to another. On the other hand, you could be called in to attend to the victim of a car accident or a shooting or a heart attack, drowning, mountaineering accident, or drug overdose. You may even have to deliver a baby! You can never predict what will happen over the course of any given shift.

As an EMT, your job responsibilities generally boil down to keeping patients alive using non-invasive medical procedures and transporting them safely to a hospital or clinic where they can receive a higher level of professional medical care. More specifically, you have three fundamental job responsibilities:

  • Assessment and stabilization of the patient’s condition
  • Basic life support
  • Transportation

In this post, we bring you up to speed on the different levels in emergency medicine and credentialing while explaining the basic education and skills required to become an EMT.

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Meet the Student: Gordon Harrison III

By NCOAE Headquarters July 6, 2019

Student Profiles

If Gordon Harrison’s name sounds familiar to you, that likely means one of two things: You either know him personally or you’re a fan of the water sport known as wakeboarding.

David “Gordon” Harrison (the third) recently graduated from one of our 19-Day ‘Intensive’ EMT-Basic training courses. And as you probably figured out by now, this native of Caroline County, Va. (who now calls Melbourne Beach, Fla. his home), holds the distinction of being the only professional athlete to enroll in that course — or any course for that matter here at The National Center for Outdoor & Adventure Education.

Harrison started wakeboarding as a child and become good enough in high school to be invited by the World Wake Association to join the Jr. Pro Wakeboard Tour. Suffice to say, he’s never looked backward since.

For the uninitiated, wakeboarding is a water-based sport in which the athlete — standing on a short board with foot bindings known as a wakeboard— is towed behind a motorboat across its wake, allowing the athlete to crest the wake for aerial maneuvers. In Harrison’s case, he’s so proficient at wakeboarding that he’s only one of a handful of people on the planet capable of making a living as a professional wakeboarder.

So, what possesses someone living the life of a pro athlete to drop everything and spend 19 days with us in North Carolina preparing to sit to for the NREMT (National Registry of Emergency Medical Technicians) exam? That’s what we wanted to know. Here’s what Harrison had to say, in his own words: (more…)

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