Employee Assistance Programs, Wellness Days Can Help Alleviate EMS Mental Health Crisis
The alarming and growing trend of first responders nationwide developing unhealthy and unsafe coping mechanisms because of their job should be a significant cause of concern. During my 15 years of working full time as a first responder, I have witnessed far too many colleagues demonstrate behaviors detrimental to their personal and professional lives. Multiple contributing factors can explain why these behaviors have developed and lead to impactful consequences; however, in most cases, a centennial event ignited the behavior.
The popular movement to “End the stigma” addressing mental well-being empowered responders to acknowledge the need to speak out and ask for help. With that comes the need for leaders to ensure that all members of their agency know and when to access their employee assistance programs (EAPs). It’s even more vital for leaders to advocate for these programs if one isn’t in place.
Mental Health Challenges
Recently, I watched the documentary “Honorable But Broken: EMS in Crisis.”1 This hour-long look at the nationwide mental health crisis facing EMTs and paramedics in EMS was a disturbing and factual description of the current state of care. The film starts with a mother sharing her story of the loss of her son. Her son was an FDNY EMT who took his own life after struggling with what he had encountered while working in EMS.
First responders experience significantly higher rates of suicidal ideation and suicide compared to the general population.2 Between 7% and 12% of EMS providers live with depression.3 Out of the general population in the United States, just 5% live with depression. Nearly 42% of EMS providers report experiencing some form of mental health concern during their careers.4 These mental health struggles include anxiety, post-traumatic stress disorder, burnout, and the development of unhealthy coping mechanisms.5
The average person may not know directly what being married or in a romantic relationship with a first responder entails. However, the struggles these men and women deal with carry into their personal lives. Currently, the divorce rate of first responders averages between 60% and 70%.6 As of May 2024, the general population's divorce rate is 42%.
Of the 50 states within our country, only 15 have deemed EMS essential. In all 50 states, firefighters and police officers are classified as vital services. The 70% of the states that don’t deem EMS essential also don’t fully recognize ongoing support for the well-being of EMS providers.
Generational Change and Union Involvement
Generational change within the workforce brings new concepts and understanding of the need to evolve. The old-school train of thought to “Suck it up and move on” is rapidly phasing out but lingers in the EMS workforce. To ensure that EMS providers and other first responders have resources readily available, the organized union involvement needs to take action.
When I started my career in 2008, my workplace wasn’t unionized. We officially unionized in Spring 2014. While it was our initial contract with our employer, there was no language granting union employees access to EAPs, if needed. This changed at the beginning of 2017, with an article added to the contract that formed a critical incident stress management (CISM) program run by our peers and the availability of other resources.
Over the years, many of my coworkers have asked to speak with members of CISM and request assistance with the services provided. The services include five free sessions with a therapist specializing in first responder trauma, material support, drug and alcohol treatment, and what was referred to as a “Wellness Day.”
The “Wellness Day” grants a union member the right to notify management that they are struggling after responding to a work-related call for service. The can have the next day off with full pay or come into work and remain at the operations center to assist in operational needs while not having to respond to calls for service. These measures have been proven to ensure the mental health and well-being of the workforce and help prevent additional numbers from adding to the already disturbingly growing statistics.
Other neighboring unions have negotiated to allow their union membership to file for short-term disability and elect to be admitted to treatment centers. The most prominent treatment center is the International Association of Fire Fighters (IAFF) Center of Excellence in Maryland. This center offers a range of support and treatment solutions for those in need. Only those affiliated with the IAFF have access to the Center of Excellence. A recognized treatment center for EMS providers has yet to be established.
The current national average for a paramedic career is 6.5 years before leaving for a different field.7 Multiple factors contribute to this low career length; those who have participated in research surveys have shared the mental and emotional toll working as a paramedic took on them is a prominent contribution to moving to a different career. This short career span has added to the national shortage of paramedics, and the paramedics currently working don’t have the field experience that comes with longevity. The lack of expertise comes with patient care concerns and mishaps that affect the short- and long-term outcomes of patients needing EMS. Research discussed by JEMS and NAEMSP has linked burnout, emotional exhaustion, and cumulative trauma exposure to workforce attrition within EMS.2,4
My career span has surpassed the 6.5-year mark. However, it has been tested. In October 2020, I was officially diagnosed with work-related post-traumatic stress disorder. From Fall 2020 to now, I have openly admitted my thoughts on a career change and shared an insight with the younger generation coming into our workforce about the importance of maintaining a healthy and safe method of coping with what we encounter daily.
I pursued a degree in EMS Administration from Eastern Oregon University in hopes of transitioning to a position that doesn’t require me to work full-time in an ambulance. My choice to pursue another higher-level degree was inspired by my desire to remain in EMS and continue the much-needed support of current and future EMTs and paramedics.
Conclusion
Recently, I discovered a quote from C.S. Lewis that moved me to tears: “You can’t go back and change the beginning, but you can start where you are and change the ending.”
This quote applies to anyone who needs a change in mindset and outlook. This is particularly important for first responders who faced their demons within their career. You can’t unsee what has come to you while attempting to help save and improve the quality of life of others. What you can do is acknowledge your feelings and thoughts. Share them with a confidante you entrust, maintain a healthy lifestyle, use available resources, and provide ongoing support to your fellow brothers and sisters you work with. We can strive to change the ending for ourselves and those who come after us.
Work Cited
1. Partnership for Change. (2023). Honorable But Broken: EMS in Crisis. Retrieved November 14, 2024.
2. Shearer, T. (2022, May 5). A Frontline Battle: The Mental Health Crisis in Emergency Medical Services. JEMS. jems.com
3. Agency for Healthcare Research and Quality. (2023, September 27). Mental Health and Occupational Stress in the Emergency Medical Services and 911 Workforce: A Systematic Review. ahrq.gov
4. Wright, D., Randolph, K., & King, K. (2023, February 8). EMS Burnout and Mental Health. National Association of EMS Physicians. nasemp.org
5. Antonellis, P. J. (2012). Chapter 9 / Stress and Psychological Support. In Labor Relations for the Fire Service (pp. 219–250). essay, PennWell. Retrieved November 10, 2024.
6. Wells, K. B. (n.d.). Examining divorce in the Orange County Fire Authority [Applied research project]. National Fire Academy. https://apps.usfa.fema.gov/pdf/efop/efo48141.pdf
7. David, G., & Harrington, S. E. (2011, November). The quality of emergency medical services (Issue Brief, Vol. 17, No. 3). Leonard Davis Institute of Health Economics, University of Pennsylvania. https://d197nivf0nbma8.cloudfront.net/uploads/archive/pdf/issuebrief%2017_3.pdf
