Tennessee Addresses EMS Retention With Dedicated Mental Health Curriculum
Editor’s note: This article is the first in a three-part series on how Tennessee is tackling retention in EMS. Parts two and three will be available in the coming weeks.
A paramedic sits in the back hallway of the emergency department, trying to write his report. He’s deciphering notes scribbled on EKG paper, tape, and the back of exam gloves—whatever he could grab during the call. Working the arrest of a second child this month wasn’t what he signed up for. He leaves his laptop and notes for his partner, sets his uniform shirt on the pile, and starts walking home.
EMS has long focused on recruitment—bringing new providers into the profession, filling vacancies, and stabilizing staffing levels. But Tennessee’s recent decision to embed mental health education into all licensed levels of EMS education reflects a different understanding of the workforce challenge: retention begins on Day One. The calls that stay with providers, the cumulative trauma that shapes careers, and the cultural expectations that define EMS all start in the classroom. Tennessee’s new Mental Health Curriculum is built on the premise that preparing providers emotionally is just as essential as preparing them clinically, and that long careers depend on early, honest conversations about the realities of the job.
Why Tennessee Acted Now
When the Tennessee EMS Board unanimously approved the statewide Mental Health Curriculum in June 2025, it marked a deliberate shift in how the state prepares and supports its EMS workforce. The decision wasn’t simply an educational update; it was a recognition that the profession’s longstanding cultural norms—strength, stoicism, and self‑sacrifice—are unsustainable in the face of cumulative trauma, burnout, and post‑COVID workforce instability.
The pandemic didn’t create the mental health challenges facing EMS, but it accelerated them. Burnout, fatigue, and workforce shortages were present long before 2020. COVID stripped away any illusion that EMS could continue operating without addressing the emotional toll of the job.
“Post‑COVID staffing challenges highlighted the urgency of this work,” said Jason Fox, Workgroup Chair. “But they weren’t the sole reason. The pandemic exposed how vulnerable our providers are when they lack the tools and support to process the emotional demands of the profession.”
The board recognized that recruitment alone wouldn’t stabilize the workforce. Tennessee, like many states, saw new providers enter the field only to leave within a few years. Without retention, recruitment becomes a revolving door. The board’s discussions increasingly centered on the idea that EMS must prepare providers for the realities of the job before they ever step into an ambulance. That meant acknowledging that mental health education isn’t a luxury or an optional add‑on—it’s a workforce necessity.
The post‑COVID environment also revealed how stressors extend beyond the clinical setting. Providers were navigating increased call volumes, staffing shortages, supply chain disruptions, and public uncertainty. Many carried those pressures home, where they affected relationships, families, and personal well‑being. The board understood that EMS stress doesn’t end when the shift does. It follows providers into their personal lives, often with long‑term consequences.
Tennessee’s response was shaped by a simple premise: if EMS expects providers to remain in the profession, it must equip them with strategies to protect their mental health throughout their careers. The curriculum is designed to help providers recognize early warning signs of distress, understand cumulative trauma, and develop healthy coping strategies. It also encourages providers to seek help sooner, reducing the likelihood of crisis‑level burnout.
The decision to act was also influenced by the growing recognition that EMS culture needed to change. The “tough it out” mentality, while deeply ingrained, has contributed to stigma around seeking help. Providers often believe that acknowledging struggle will lead others to question their competence. Tennessee’s curriculum challenges that belief directly. It sends a clear message: acknowledging mental health challenges isn’t a sign of weakness—it’s a sign of professionalism.
“The question isn’t if EMS will affect your mental health,” Fox said. “The question is when and how.”
Culture Starts in the Classroom
The Education Committee understood that culture begins early. Many students entering EMS have never witnessed death, dying, or the types of traumas they will inevitably encounter. The first exposure to these realities can be overwhelming, and without preparation, new providers may internalize harmful beliefs about how they are expected to cope.
The curriculum was developed by a statewide workgroup of EMS educators, clinicians, mental health advocates, and frontline providers. Their goal was to create a practical, relevant, and emotionally honest foundation for new EMS professionals. The workgroup included representatives from urban, suburban, and rural agencies, ensuring the curriculum reflected the diverse experiences of Tennessee’s EMS system.
The curriculum addresses cumulative trauma, early warning signs of distress, healthy coping strategies, resilience skills, peer‑support principles, and the reality that stress follows providers home, affecting families and relationships. It also includes guidance for instructors, reminding them that their role extends beyond delivering content. Instructors are encouraged to create safe learning environments where difficult conversations can occur openly. The curriculum acknowledges that these discussions may evoke strong emotions for both students and instructors.
By embedding mental health education into initial training, Tennessee is attempting to shift the culture of EMS from the ground up. Students learn that emotional wellness is part of professional competency. They also learn that mental health challenges are common, expected, and manageable when addressed early. This early exposure helps normalize conversations about mental health and reduces stigma across the profession.
A Workforce Strategy, Not a Standalone Fix
The curriculum is part of a broader statewide workforce strategy that includes leadership development, listening sessions, and the Tennessee Department of Health’s Emergency Preparedness program’s push for Mental Health First Aid (MHFA). MHFA teaches individuals how to recognize distress, initiate supportive conversations, and connect people with resources. The EMS curriculum builds on those principles by focusing specifically on the emotional realities of emergency services. Together, these initiatives reinforce the message that mental health is everyone’s responsibility.
The workgroup agreed that mental health is a significant factor in early attrition. Providers often leave the profession earlier than they intended because the emotional toll becomes unsustainable.
“Our hope is that by introducing these conversations and coping strategies at the beginning of someone’s career, we can help providers develop healthier habits, seek support sooner, and ultimately enjoy longer, more fulfilling careers,” Fox said.
The statewide strategy also includes efforts to strengthen leadership. Tennessee has invested in leadership development programs that encourage supervisors to recognize signs of distress, support their teams, and foster healthier work environments. Listening sessions across the state have provided insight into the challenges providers face, helping shape policy decisions and workforce initiatives.
Measuring culture change is difficult, but Fox is clear about what success looks like: fewer divorces, fewer hardships, fewer deaths among EMS providers, more open conversations, more willingness to seek help, and stronger peer support.
“If providers are talking more openly about mental health, checking on one another, and seeking help sooner, then we’ve accomplished something meaningful,” he said.
Fox’s EMS World series last year sparked statewide dialogue about mental health in EMS. Providers reached out, shared their stories, and voiced concerns that had long gone unspoken.
“The articles raised awareness,” Fox said. “The curriculum takes those ideas and transforms them into action.”
A Living Curriculum for a Changing Profession
The curriculum is intentionally designed as a living document. The Education Committee will review it annually, incorporating new data, best practices, and emerging research. Virtual instructor sessions and statewide support resources will help ensure consistency and continuous improvement.
The EMS Board has also approved a recommendation that at least one hour of annual in-service education be dedicated to mental health, ensuring providers receive ongoing support throughout their careers. This requirement reinforces the idea that mental health education isn’t a one‑time event but an ongoing professional responsibility.
Tennessee’s Mental Health Curriculum represents a cultural shift and a workforce strategy rooted in the realities of modern EMS. The profession can’t pour from an empty cup. If EMS expects providers to continue caring for others, it must teach them how to care for themselves. Retention begins in initial EMS education—and Tennessee has decided to embrace that reality.
References
Fox, J. (2025). EMS World Mental Health Series. EMS World.
Tennessee EMS Board. (2025). Approved Minutes: Board Meeting, June 16, 2025. https://www.tn.gov/content/dam/tn/health/events/Approved%20Minutes%20Board%20Meeting%20June%2016,%202025.pdf
Tennessee EMS Education Association. (2025). Approved Mental Health Curriculum. https://www.tnemsea.com/mental health
Tennessee Department of Health, Emergency Preparedness Program. (2025). Mental Health First Aid. https://www.tn.gov/health/mhfa.html
