As we start EMS Week, the importance of support for those who sacrifice for their communities is highlighted in the topic of the day. The first day focuses on the Health, Wellness and Resilience of first responders. Emergency medical technicians, advanced EMTs and paramedics are the backbone of prehospital medical care in the U.S. and provide care in a manner that has significantly improved short- and long-term patient outcomes.
Birth of EMS
Emergency medical services (EMS) is a collective term for highly trained medical personnel commonly found in the out-of-hospital, prehospital or community setting. These professionals are not nurses yet go through similar educational requirements and work under the guidance and authority of a medical director or control physician. With over 650 nationally accredited paramedic programs in the U.S., the majority in two-year or four-year colleges, the educational foundation similarly matches that of other allied health or health science professions. Modern-day EMS was created as the result of the 1966 White paper produced by the National Research Council entitled Accidental Death and Disability: The Neglected Disease of Modern Society. The findings concluded that the high rates of accidental death in the U.S. due to traffic accidents and the subsequent care of this population was disproportional to the care provided to combat injuries during the Korean War. This trend of an inequable response and care for these types of traumatic incidents continued to be seen during the Vietnam War.
COVID-19
EMS professionals while often highlighted during the COVID-19 response are often forgotten and misunderstood in the group of professionals typically recognized for their service to their communities. Fire and Police tend to receive the bulk of the recognition for their impacts on their communities. This oversight further impacts the population that is already stressed as the basis of their chosen profession.1 On a daily basis EMS professional will experience common job-related stress associated with physical, emotional and mental pressure of their shifts. The recognition of the stressful environment of out-of-hospital medical service has become important for this population yet the effects are still being seen on a tragic level.
PTSD
Post-traumatic stress disorder (PTSD) rates have been reported as high as four-times higher than the typical rates of the general population.2 Through the combined research and review of 27 international studies the prevalence of mental health issues was significant, 11% of personnel are reporting PTSD, 15% depression, 15% anxiety, 27% for general psychological distress and 10% had suicidal ideations.1 One Canadian based study showed that 44.5% of respondents showed clinically significant symptoms for diagnosable mental disorders.1
Sleep (Or Lack Thereof)
Further complicating the professional environment and added stress to this health care population is the presence of the sleep deprivation experienced as a job-related consequence. Disorders in the sleep-wake circadian rhythm has shown to impact the overall health of EMS professionals especially those working 24hr shifts or longer.3 While sleep deprivation has been associated with fatigue-related injuries and job performance errors it has also been associated with other chronic diseases such as diabetes, obesity, cardiovascular issues, chronic obstructive pulmonary disease and certain forms of cancer.4 Given these working environments are not unique a comparison study conducted by the U.S. Department of Labor found that EMS professionals were more likely to miss work due to injury or illness than those in the police or fire services. Even more troubling was found in a study in 2016 that 2/3rd of EMS providers experienced some form of violence directed towards them in the last 12 months.
How to Get Help
As is often quoted the first step is recognition that there is a problem, and our EMS professionals are well past that point. The profession continues to struggle with these issues and the recent COVID-19 pandemic has brought the burn out and retention of EMS professionals to a head. Only through programs such as the Code Green Campaign and agencies such as the NAEMT have the issues been brought to the forefront. Through the education of the workforce as well as raising awareness to the general public these agencies are attempting to turn the tide on these issues that ultimately impact the U.S. health care system as a whole.
References
1. Lawn, S., Roberts, L., Willis, E. et al. The effects of emergency medical service work on the psychological, physical, and social well-being of ambulance personnel: a systematic review of qualitative research. BMC Psychiatry 20, 348 (2020). https://doi.org/10.1186/s12888-020-02752-4
2. Adams, Shahieda, Nraramala, Itumeleng. The correlates of post-traumatic stress disorder in ambulance personnel and barriers faced in accessing care for work-related stress. International journal of environmental research and public health. https://pubmed.ncbi.nlm.nih.gov/35206234/
3. Mountfort S, Wilson J. EMS Provider Health And Wellness. [Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493236
4. Caruso CC. Negative impacts of shiftwork and long work hours. Rehabil Nurs. 2014 Jan-Feb;39(1):16-25. doi: 10.1002/rnj.107. Epub 2013 Jun 18. PMID: 23780784; PMCID: PMC4629843.
