Administration and Leadership, Columns

New Alliance Signals Industry-Wide Effort to Curb EMS Provider Stress and Suicide

Issue 8 and Volume 42.

The reality is that stress is inherent in the job of EMTs and paramedics. No one calls us with good news. We’re sent to the worst moments in patients’ lives, in their family members’ lives and, quite often, our lives.

Our minds are like powerful cameras and recorders that can’t have files erased. We can modify those files (i.e., memories) but never completely erase them.

It’s important for new as well as experienced responders to recognize these simple truths and be provided with the skills to confront them.

In the 2013 publication, First Response Resiliency, authors Philip Callahan, PhD, EMT-P; EMS10 award winner Michael Marks, PhD, ABPP; and Mike Grill, MS, NRP, first called attention to the need for resiliency training to prepare and harden new and veteran personnel to stress, noting that stress is inherent and expected in a profession where life-and-death circumstances are coupled with unpredictable and non-specific threats. Mental health has emerged as decisive to performance, retention, and quality of life.1

The authors also pointed out that prolonged work-related stress has been associated with mental health concerns, citing a law enforcement study that found five core areas where most officers frequently fail: addictive issues, behavioral health, physical health, personality issues and family-relationships.2

The Alliance on EMS Resiliency was announced at the EMS Today Conference in February by its cofounders, JEMS and the National EMS Management Association (NEMSMA) Practitioner Mental Health and Wellbeing committee, as an industry-wide effort to curb EMS provider stress and suicide by offering valuable, lifesaving support to EMS personnel worldwide.

On June 12, 2016, the inaugural meeting of the Alliance on EMS Resiliency was held at the Department of Homeland Security in Washington, D.C., graciously hosted by the Office of Health Affairs.

This brief article will give you the background and an update on this powerful
new alliance.

Birth of an Alliance

The alliance was born out of a phone call I received from ZOLL Senior Director Michael Parascandola. He called me because he’d heard me present the horrible, escalating statistics on EMS stress and suicide at the EMS Today Conference keynote addresses in 2015 and 2016 and wanted to know what more he-and ZOLL-could do to reduce these occurrences.

It turns out that EMS stress and suicide struck close to home when his daughter and son-in-law, both involved in EMS, had awful experiences with colleagues who committed suicide.

His call was a catalyst for action and I arranged for him to meet with Monique Rose, EMT-P, and Pat Songer at the 2017 Annual Meeting of the National Association of EMS Physicians (NAEMSP).

Rose and Songer were both members of the NEMSMA Practitioner Mental Health and Wellbeing Committee, a group actively involved in developing an action plan to bolster provider resiliency, reduce provider stress, and, most importantly, reduce provider suicide.

Monique was also a founding member of Reviving Responders, which started as a project assignment for the Fitch Leadership Academy’s Ambulance Service Manager course, and has blossomed into a group dedicated to changing the culture of EMS because of the unacceptable suicide rates in our profession. JEMS published their epic work and survey data on stress and suicide in October 2015, which subsequently lit a wildfire of concern throughout the emergency services industry.3

Responses to their survey revealed that EMS providers were finally admitting that they hadn’t just experienced stress that haunted them, but stress that caused many of them to contemplate suicide.

The deep dive into the data and responses revealed what many of us had theorized for years: A majority of supervisors, partners and colleagues weren’t supportive of their concerns about stress and, worse yet, often chastised or belittled them if they came forward.

The data also showed that many agencies didn’t have employee assistance programs (EAPs) or, if they did, the counselors didn’t understand the unique complexities and stressors in EMS.

Groups like Reviving Responders and others such as the Code Green Campaign emerged to raise awareness and find the underlying causes of why emergency responders choose suicide rather than training
or therapy.

It turned out that there was not much being offered in the way of formalized, evidence-based programs to support the mental health of emergency responders. The programs that were available were in pockets of expertise, such as associations or states, and there was nothing universally available or coordinated nationally or internationally.

At our NAEMSP meeting, our small group agreed that a multimodal, multi-agency approach, based on hard evidence, scientific research and proven approaches.

Through a strong, unified alliance of like-minded associations, individuals and emergency service leaders committed to working toward common goals, we can educate responders about the inherent stress of our occupation, train them to be resilient, eliminate the stigma of mental health issues and decrease the number of suicides in our ranks.

Following our meeting at NAEMSP, we attended a powerful and inspirational session on resiliency presented by U.S. Air Force Col. Chetan Kharod, MD, MPH. It was almost prophetic, as his words echoed those in our meeting notes.

Karod noted that, although firefighters, EMS personnel and law enforcement officers embody a proud tradition of compassionate, selfless service, the reality is that many of these special men and women will encounter emotions and situations beyond the range of normal human experience over the span of their careers. Similar experiences to this were seen in the U.S. Special Operations community, where senior leaders realized that preservation of the force and family is essential. Responders will often continue to persevere and serve even as the service they render takes its toll on their own physical, mental, spiritual and social well-being.

Over the next few weeks, Monique and I reached out to agencies and organizations to determine if there was interest in the formation of an industry-wide alliance to jointly attack the escalating stress and suicide issues affecting paid and volunteer EMS personnel.

Overwhelming Response

Although many of the associations had programs in existence or under development, and others were aware and concerned about the issues, our goal was to develop a unified group that would openly acknowledge the problem, discuss it, and then collaborate and combine efforts to raise awareness, educate and develop resiliency training and best practices.

Every agency and association we approached wished to join the alliance, pledging to work together with a unified voice.

When introducing the Alliance on EMS Resiliency in Salt Lake City in February, I anncounced that our industry is united in acknowledging that suicide among emergency responders is a problem that’s no longer acceptable and that critical stress training and prevention measures were long overdue.

The announcement was greeted enthusiastically. And, although JEMS is a founding organization and will act as the primary media partner for the alliance, I invited representatives from other media outlets such as EMS World and EMS1 to participate.

The initial members of this amazing alliance are listed here so you can see and appreciate who they are. Why did so many associations, each with their own specific needs, programs and agendas, and who often strive to be unique and different from one another, agree to come together? Because it’s a common cause, and stress doesn’t discriminate.

Stress will attack anyone who’s vulnerable, and we’re all vulnerable. Stress and suicide is an issue that exists and permeates in all levels of emergency response organizations, from dispatchers to first responders, EMTs and paramedics, flight crews and ED staff. None of us, and more importantly, none of our personnel, are immune to it.

Committing to Change

The Alliance on EMS Resiliency and its member organizations want to help you recognize stress that may be crippling you internally and affecting your ability to do your job, get along with your co-workers, relate your concerns to your family members and friends, shed the demons that lurk in your brain and haunt you, and enable you to harden yourself against them, sleep peacefully and move on.

At the inaugural meeting, member organizations committed to working under a common mission statement and agenda, agreed to explore the possibilities of specific initiatives to address mental health, social strength and physical fitness for their members and agreed to use proven science and programs properly vetted through experts in this area to ensure you receive education in resiliency and to provide mental health assistance and care when you need it.

Most importantly, we have all pledged to help change our industry’s culture by eliminating the stigma behind discussing stress and to encourage people to seek out mental health assistance.

We want you to know that we have your back. 


1. Callahan P, Marks M, Grill M, et al. First response resiliency. OneTreePsych: 2013.

2. Nanavaty B; Hofmann D. (January 2014.) Why officers and agencies fail: A case for resiliency in policing. Legal and Liability Risk Management Institute. Retrieved June 26, 2017, from

3. Newland C, Barber E, Rose M, et al. Critical stress: Survey reveals alarming rates of EMS provider stress and thoughts of suicide. JEMS. 2015;40(10):30-34.

Alliance on EMS Resiliency Member Organizations

  • American Ambulance Association (AAA)
  • Centura Health
  • Code Green Campaign
  • Department of Homeland Security
  • EMS1
  • EMS World
  • Georgia Office of EMS/Trauma
  • International Academies of Emergency Dispatch (IAED)
  • International Association of Fire Chiefs (IAFC)
  • International Association of Firefighters (IAFF)
  • ImageTrend
  • International Critical Incident Stress Foundation
  • JEMS (Journal of Emergency Medical Services)
  • National Academies of Sciences, Engineering and Medicine
  • National Association of EMS Educators (NAEMSE)
  • National Association of EMS Physicians (NAEMSP)
  • National Association of EMTS (NAEMT)
  • National Association of State EMS Officials (NASEMSO)
  • National EMS Management Association (NEMSMA)
  • National Registry of EMTs (NREMT)
  • National Volunteer Fire Council (NVFC)
  • Paramedics Australasia
  • Reviving Responders
  • Safe Call Now
  • Strub Caulkins Center for Suicide Research
  • Texas Office of EMS/Trauma System
  • The Paramedic Foundation
  • U.S. Military Department of EMS & Disaster Medicine Fellowship
  • ZOLL Medical