Behavioral Health Conditions in Emergency Medical Services (EMS) Personnel

One of the core risk factors for first responders is the pace of their work. First responders are always on the front line facing highly stressful and risky calls. This tempo can lead to an inability to integrate work experiences. For instance, according to a study, 69 percent of emergency medical service (EMS) professionals have never had enough time to recover between traumatic events.¹ As a result, depression, stress and post-traumatic stress symptoms, suicidal ideation, and a host of other functional and relational conditions have been reported.

Depression

Depression is commonly reported in first responders, and rates of depression as well as severity vary across studies. For instance, in a case-control study of certified EMS professionals, depression was reported in 6.8 percent, with mild depression the most common type (3.5 percent).¹ Among medical team workers responding to the great East Japan earthquake (2011), 21.4 percent were diagnosed with clinical depression.² In a study in Germany, 3.1 percent of emergency physicians had clinical depression.³

Stress and Post-Traumatic Stress Disorder/Symptoms

Stress symptoms and post-traumatic stress symptoms in EMS personnel have been reported in a numberof studies. For instance, in a review of published literature, EMS/paramedics reported higher peritraumatic dissociation (feelings of dissociation, depersonalization, emotional numbness, altered time perception, and other complex reactions felt during traumatic events) at the time of the Loma Prieta Bay Area earthquake (1989) compared with the police.⁴ In a study in Germany, 16.8 percent of emergency physicians had probable and post-traumatic stress disorder (PTSD).⁴ In a case-control study among certified EMS professionals, stress was reported in 5.9 percent, with mild stress the most common type (3.1 percent).¹

Suicide/Suicide Ideation

Suicidal ideation has been reported in first responders in a number of studies, but there is still a question as to the rates given the way data has been collected (i.e. in samples of convenience versus the use of random samples). However, existing research suggests that EMS personnel may be more likely than the general population to think about and attempt suicide. For instance, in a literature review, suicidal thoughts and ideations in EMS/paramedics were evaluated as compared to those in the general population.⁵ Based on findings from a study included in the review—only two studies of suicidality in EMS personnel met the criteria for the review—authors found a lifetime prevalence rate of 28 percent for feeling life is not worth living, 10.4 percent for serious suicidal ideation, and 3.1 percent for a past suicide attempt.⁵ In another study in the same review, it was found that having both EMS and firefighting duties was associated with a six-fold increase in the likelihood of reporting a suicide attempt as compared to firefighting alone.⁵ In a separate study, 37 percent of fire and EMS professionals have contemplated suicide, nearly 10 times the rate of American adults.⁶ In addition, 6.6 percent of fire and EMS professionals reported having attempted suicide, as compared with just 0.5 percent of civilians. More work needs to be done with better controlled studies, but the extant data is suggestive of higher rates within first responder populations.

References

1. Bentley, M.A., Crawford, J.M., Wilkins, J.R., Fernandez, A.R., & Studnek, J.R. (2013). An assessment of depression, anxiety, and stress among nationally certified EMS professionals. Prehospital Emergency Care, 17(3), 330–338. doi: 10.3109/10903127.2012.761307
2. Garbern, S.C., Ebbeling, L.G., & Bartels, S.A. (2016). A systematic review of health outcomes among disaster and humanitarian responders. Prehospital and Disaster Medicine, 31(6), 635–642. doi: 10.1017/s1049023x16000832
3. Pajonk, F.G., Cransac, P., Muller, V., Teichmann, A., & Meyer, W. (2012). Trauma and stress-related disorders in German emergency physicians: The predictive role of personality factors. International Journal of Emergency Mental Health and Human Resilience, 14(4), 257–268.
4. Marmar, C.R., McCaslin, S.E., Metzler, T.J., Best, S., Weiss, D.S., Fagan, J., et al. (2006). Predictors of posttraumatic stress in police and other first responders. Annals of the New York Academy of Sciences, 1071, 1–18. doi: 10.1196/annals.1364.001
5. Stanley, I.H., Hom, M.A., & Joiner, T.E. (2016). A systematic review of suicidal thoughts and behaviors among police officers, firefighters, EMTs, and paramedics. Clinical Psychology Review, 44, 25–44. doi: 10.1016/j.cpr.2015.12.002
6. Abbot, C., Barber, E., Burke, B., Harvey, J., Newland, C., Rose, M., & Young, A. (2015). What's killing our medics? Ambulance Service Manager Program. Conifer, CO: Reviving Responders. Retrieved February 1, 2024, from www.revivingresponders.com