Introduction

Emergency medical services (EMS) workers may experience mental, physical, and emotional stress every shift. In addition to high levels of stress, they are experiencing increasing incidents of posttraumatic stress disorder (PTSD) and on-the-job injuries. These issues contribute to high rates of suicide, job-related burnout, clinical depression, and physical conditions, which can prevent EMS providers to continue working in the field. Personal health and physical, emotional, and mental wellness are critical in helping EMS workers survive in their careers.[1][2][3][4][5]

EMS workers are highly trained medical personnel who assist or work as an extension of a physician, usually in the prehospital setting. Modern-day EMS began after the National Research Council released its 1966 White paper titled Accidental Death and Disability: The Neglected Disease of Modern Society. It found that due to the high incidence of accidental death in the United States, public safety needed to include national, standardized, and advanced medical training. This paper was the impetus for the National Standard Paramedic Curriculum.

In 2014, the United States (US) Department of Labor Bureau of Labor Statistics estimated 241,200 paramedic jobs, with a predicted 24% job growth rate over the following 8 years. Since its inception, EMS providers have long been known for their ability to help patients in the most extreme circumstances. This may happen in any setting, from the middle of a major interstate highway during the summer heat to the open farmlands in freezing temperatures to the highest-crime areas of cities. Along with dealing with difficult environments and high patient acuity, the release of catecholamines while driving "lights and sirens" has labeled many in the industry as "adrenaline junkies." These aspects of the job attract specific personality types to the EMS field. Dr. Jeffery Mitchell documented general personality traits of emergency personnel as:

• Need to be in control
• Obsessive
• Compulsive
• Highly motivated by internal factors
• Action-oriented
• High need for stimulation
• Need immediate gratification
• Easily bored
• Risk takers
• Rescue personality
• Highly dedicated
• Strong demand to be needed

Mitchell stated that these traits make EMS workers continue to work, even in the face of harm to themselves. In addition to the mental and emotional toll the industry can take on the provider, it is not uncommon to go from deep sleep to moving a 300-pound (136 kg) patient 15 minutes later. There is no time for stretching or warming the muscles before they are stressed. Furthermore, until recently, most EMS agencies worked 24-hour shifts for their employees. In addition to low wages and the need for multiple jobs, this schedule was a significant reason for the sleep debt providers incurred. Sleep debt is the difference between the amount the EMS provider can obtain and the amount of sleep the EMS provider requires not to feel severely tired. Over one-half of all EMS workers report inadequate sleep, poor sleep quality, and/or poor recovery between shifts.[6][7]

Issues of Concern

Stress is an everyday part of an EMS worker's career. It can be categorized in 2 ways: eustress and distress. Eustress is known as "positive stress." This can be found in things like getting a raise at work, becoming married, finding out about an expecting child, or having family members visit. Distress is the opposite. It is "negative stress," such as a family member's death, monetary debt, divorce, having a patient die, or difficulties with fellow employees at work. This stress, along with poor sleeping patterns and inadequate eating habits, have been some of the causes of the high number of EMS job-related burnouts. These high-intensity stressors can lead to acute stress reactions, delayed stress reactions, and cumulative stress reactions. It can also lead to anxiety, depression, substance abuse disorder, PTSD, and suicide.

Due to the unknown nature of when emergency responses are needed, EMS crews rarely have set schedules for eating. This uncertainty leads to eating food that they can purchase quickly and inexpensively (fast food). This was reflected in a study published in 2009 by the journal Obesity that found 75% of the fire department and EMS recruits to be either overweight or obese.

In the last 25 years, sleep disorders have become a great concern for public health. Conditions such as sleep apnea, insomnia, and circadian rhythm sleep-wake disorders have been shown to have grave health effects on patients. Of these, circadian rhythm sleep-wake disorders play a big role in EMS workers' health. This is due to the 24-hour shift work and the constant waking to respond to emergency calls.

According to the US Department of Labor, EMS providers suffer more work-related injuries than the average public. More specifically, in 2009, a study comparing public safety provider injury rates found that EMS practitioners are likelier to miss work because of injury than those in the Fire or Police services. Additionally, in 2016, a study found that two-thirds of EMS providers reported they experienced at least one form of violence in the previous 12 months.

Clinical Significance

The first step in solving these problems is to acknowledge the problem. Throughout most of EMS history, it was considered weak for the provider to admit there were any responses to these stressful stimuli—programs such as the Code Green campaign act as an EMS mental health advocacy and education organization. The organization states, "The campaign has 2 main goals. Our primary goal is to raise awareness of the high rates of mental health issues that affect first responders. Due to the stresses to which first responders are exposed, they have increased rates of PTSD, depression, anxiety, substance abuse, and suicide. In addition, we aim to educate responders on multiple mental health-related topics." 

Code Green and other entities, such as The National Association of Emergency Medical Technicians, the Journal of Emergency Medical Services, and EMS1, have been attempting to educate providers on the dangers of these stressors with courses on resiliency, work/life balance, and seeking help when needed.

EMS workers have faced health and wellness challenges since the inception of modern-day EMS. Only in recent years has the industry begun to attempt to study the causes and workable solutions to these problems. To rectify these challenges, education, willingness to study, acceptance of the problems, and a change in the culture of EMS providers is necessary.[8][9][10]