Job Stress and What to Do About It

For EMTs and paramedics dealing with PTSD and other forms of traumatic stress, every shift at work can make their symptoms worse. At the same time, there are positive steps these EMS providers can take to mitigate their symptoms, especially if they receive support from family, friends, and employers.

These are some of the findings detailed in a new paper, “Dynamic Psychosocial Risk and Protective Factors Associated with Mental Health in Emergency Medical Service (EMS) Personnel,” recently published in the Journal of Affective Disorders.

“EMS workers encounter a variety of occupational challenges that can impose a significant mental health burden,” says Bryce Hruska, PhD, a study coauthor and assistant professor of public health at Syracuse University’s Falk College of Sport and Human Dynamics. “We wanted to better identify the specific challenges workers encounter each day on the job. And, just as important, we wanted to better understand what protective behaviors EMS workers naturally engage in to navigate these challenges and maintain their mental health.”

A Constant Fact of Life

The study’s authors asked 79 EMS workers at American Medical Response in Syracuse, N.Y., to complete eight daily surveys. The surveys included questions about occupational stressors encountered by the workers, their sleep efficiency and social conflicts, and any meanings they were able to derive from the day’s challenges. Participants were also asked about recovery activities they engaged in, social support they received, and the perceived prosocial impact of their work.

“This design allowed us to consider how day-to-day fluctuations in the challenges workers experienced and the protective behaviors they engaged in related to daily fluctuations in mental health symptoms,” says Hruska.           

As one might expect, being an EMS provider can be hard on a person’s mental and emotional health, particularly if they are living with PTSD. In fact, “we found the occupational stressors EMS workers experienced each day caused a spike in the PTSD symptoms they experienced each day,” Hruska says. “These stressors were in the form of critical events (e.g., patient deaths) and work demands (e.g., managing patients’ friends/families). We also found that daily social conflicts on the job or at home led to elevations in daily depression symptoms.”

Such stressors are a constant fact of EMS life, cropping up repeatedly during the eight days the study’s participants were surveyed. “We found that over two-thirds of the EMS workers responded to at least one critical event during the course of the study,” Hruska notes. “We defined critical events as incidents in the field involving patient death or actual or threatened injury to either patients or the workers who responded to the call. These types of events are especially emotionally taxing.”

The study’s researchers also learned that EMS workers regularly experience work demands in the form of high-call-volume shifts, managing patients’ friends and relatives, and experiencing poor communication with coworkers.

“We found that over 80% of the workers in our study had at least one social conflict with a coworker, supervisor, significant other, or other friends and family,” says Hruska. “While these types of stressors may not be as emotionally demanding as critical events, they are quite common and may be detrimental to mental health due to their chronicity.”

The human toll inflected by these stressors can be severe. Left untreated, mental health problems stemming from PTSD and depression symptoms can lead to burnout, turnover, and even suicide.

Ways to Cope

In surveying the 79 EMS workers, the study’s team sought their input on ways to cope with recurring PTSD symptoms and the daily stressors of the job.

The good news: “One of the most exciting findings from our research is that there are specific actions workers can take each day to take care of their mental health,” Hruska says. “For example, recognizing stressors or conflicts as opportunities for learning and growing may be a useful tactic for effectively resolving the situation with fewer negative mental health effects.”

Additionally, EMS workers who take the time to recharge and recover after particularly demanding shifts can let emotions cool down. Others are helped by finding personal meanings and lessons to be learned from their daily challenges.

As well, EMS providers who have access to positive social support do better in coping with daily job stress.

“Doing something with friends and family can be helpful, since healthy social support assists with coping efforts and helping to reframe the day’s stressors,” says Hruska. “If they are able to find time to engage in recovery activities like exercising or sharing a meal with friends or family, they experience fewer depression symptoms.”

EMS Employers Need to Help

Traditionally, many EMS employers have expected their personnel to shake off the traumas they face at work, in keeping with the historically guarded emotional culture of the first responder community. “I do think this is changing,” says Hruska. “I think EMS employers are both recognizing the importance of mental health and wanting to better understand how to support their workers, and I think this study is a good example of that.”

How might this be done? “When EMS personnel respond to a critical event, we know that scheduled downtime is important,” Hruska says. “Our research suggests it may provide an opportunity for recovery and processing the day’s events. I also think efforts to develop or refine positive communications strategies for EMS personnel may be helpful for reducing the stress that accompanies managing patients’ families and friends, as well as working with coworkers.”

Looking ahead, Hruska wants to investigate how the EMS community can create tools and work environments to support the protective behaviors his team observed during their research.

“My collaborators and I are currently working on a follow-up study that will do that by assisting EMS workers with processing the day’s events and participating in recovery activities they find enjoyable,” he says. “The service that EMS workers provide is essential, and we want to help support their well-being as they work to support their patients.”

James Careless is a freelance writer and frequent contributor to EMS World.