The Stress in EMS: Effects of Stress on the Unsung Heroes of the EMS Profession

You might be an EMT if”¦you are willing to take on a high-stress profession that requires state-mandated training to respond to life and death decision-making calls and be willing to accept a lower-than-normal salary than other first responders.

EMTs are often the lifeline for patients between the location of the incident and the hospital. The hours are long and the job often requires 24-hour shifts.

EMT training is essential life-saving instruction. What EMS personnel often share with other first responding professions is that their chosen profession also comes with a high dose of stress.

EMTs Are Low in Pay–High on Stress

The 2011 Career Cast Report lists EMTs as the 9th most stressful career. Perhaps that’s not so surprising considering EMTs get exposed to trauma, violence and death on nearly every shift. After the calls are over, EMTs have to deal with work-related stressors like shift work, scheduling demands and relationship stressors with peers and superiors.

Stress is an on-the-job health risk that EMTs knowingly accept in exchange for a median national salary of only $30,168.

Emergency Calls That Cause Stress

EMTs are frequently confronted with life-threatening calls like a cardiac, respiratory, or diabetic emergencies as well as behavioral or mental health emergencies, severe trauma, allergic reactions, suspected poisonings and childbirth. The effects of stress from life-threatening emergencies compound over time and they last long after the emergency calls end.

Emergency Calls Stress the Body in Phases

In the heat of an emergency call, adrenalin kicks in and EMTs put their training to work to save lives. As they focus on the emergency at hand, the effects of stress are taking a toll on their physical, mental and emotional states.

Stress manifests itself in three phases: the alarm phase, the resistance phase and the exhaustion phase. Having a better understanding of the phases helps EMTs to know how best to take care of themselves through each phase.

  1. Alarm phase: This initial phase is when adrenalin increase after the initial reaction.
  2. Resistance phase: During this phase, the body adapts and copes with the stressor, but it also drains the body’s energy reserves.
  3. Exhaustion phase: This is the point where the body runs out of energy and it becomes difficult to think and function.

Signs of Stress in EMTs

All EMTs are affected by stress, but everyone’s body manages it differently. If you are concerned about signs of stress in yourself or someone you care about, pay attention to warning signs that affect mental and emotional health.

It’s common for EMTs with chronic stress to have difficulty concentrating because of having consistent feelings of being overwhelmed. Look for mood changes like chronic agitation and irritability. There may be signs of obsessive or compulsive behaviors or signs of becoming socially withdrawn.

Stress hibernates in the body and causes physical symptoms like frequent headaches, constant fatigue, weight fluctuations, sleep disruption, panic attacks, stomach aches and pervasive sweating. Taking action to reduce stress counteracts some of the negative effects of stress.

Doing Your Best to Keep EMT Stress at Bay

There’s no way for EMTs to side-step the effects of on-the-job stress, but they can practice habits to reduce the symptoms. You all know those “negative Nellies” who are always complaining and bringing out the worst in any situation. Negativity is contagious, and stressed-out EMTs are vulnerable targets. Do your best to keep the tone at your workplace positive and ask everyone to respect that for the good of everyone. If it continues to be a problem, remove yourself from the immediate vicinity and find a quieter, more positive space to spend your time.

When the stress is really bad, take a break. It can be a short break like a much-needed day off or turning down an overtime shift, or a longer break like a vacation or mental health break. Strategically plan for some relaxing activities like sleeping in, walking on the beach or just getting unplugged from the hustle and bustle of the busyness of life.

Find a relaxing activity that you can practice in between calls. Take a walk, practice Tai Chi, do some meditation, use it as a prayer time, practice deep breathing techniques, or keep a book in the truck.

Rely on your supervisors and veteran EMTs to learn how they cope with the stressors of the job. They may have different coping strategies than you, but you’ll find strength in sharing experiences, and you just might pick up a few helpful tips.

Where Do EMTs Find Help for Dealing with Occupational Stress?

Many EMTs can look to their employers for help dealing with crisis calls. Some employers offer critical incident stress management (CISM) or critical incident stress debriefing (CISD).

Supervisors use CISM after life-threatening or multiple-casualty incidents to help EMT’s de-escalate and diffuse their emotions before the stress of the event has a chance to take root in their brains.

Management also uses CISD for traumatic and significant incidents or accidents, typically within 24 hours after the event. Many employers also offer referrals for therapy or other treatment by mental health professionals for trauma and PTSD.

To best support the need for the health and well-being of EMTs, managers and EMTs need to work together to form an internal culture that recognizes all forms of occupational stressors inside and outside of the stationhouse and address them in a positive, supportive manner.

EMTs that lack support within their supervisors and peers can seek referrals for therapy or other treatments from their physicians.

It helps for families to be involved in the healing process as they are affected by the ancillary effects of stress. Many EMT families get acquainted inside and outside of the stationhouse and serve as support for one another.

Some Final Words on EMTs and Stress

Left unaddressed, the resulting stress from crisis calls can result in mental or physical health problems many years later. Having stress goes hand-in-hand with serving your community as an EMT. Learn about the signs of stress and watch for them in yourself and your peers. Be proactive by forming de-stressing habits as a way of life. When you feel the effects of stress and are willing to take steps to remediate it, you might be an EMT that manages stress well.


Mark Lamplugh is a fourth-generation firefighter and former captain with the Lower Chichester (PA) Fire Company. He was the Chief Executive Officer of 360 Wellness Inc. ( and currently the Vice President of Business Development of the Frontline Program ( at Sprout Health Group ( Lamplugh is also nationally recognized in Crisis Stress Intervention through the American Academy of Experts in Traumatic Stress. He has helped hundreds of firefighters, police officers, veterans, EMS personnel, and civilians nationwide find help for addiction, alcoholism, PTSD, and mental health support. He can be reached for comment at


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