Combatting burnout in EMS: Workplace strategies for better mental health support

By Carlene Robinson, DrPH, MPH; Jessica Schwind, PhD; Andrew Hansen, DrPH; Kelly Sullivan, PhD, FACE

EMS systems are an integral part of the medical system. Approximately 261,000 employees make up the national EMS workforce [1]. In 2021, personnel mental health and personnel safety (along with retention of quality personnel) topped the list of most critical issues facing EMS in the EMS Trend Report, produced by Fitch & Associates and EMS1 [2]. Sometimes, caring for injured patients in the field exposes EMS personnel to unsafe working conditions, emphasizing the potential of the workplace to serve as an occupational health intervention site.

|More: Explore the latest trends in EMS in the What Paramedics Want in 2024 report – the latest iteration of the EMS Trend Report.

The repetitive, constant loss of life across various patients is a major contributor to the increased psychological distress and stress EMS personnel may experience. This could include EMS calls for strokes, heart attacks and motor vehicle injuries. Research shows that health professionals can experience various psychological distress (such as depression, anxiety and difficulty sleeping) when working in high-pressure and high-risk scenarios, such as in times of disaster and pandemic [3]. Stress contributes to emotional problems (such as mood stabilization, anxiety, depression and burnout) and cognitive dysfunction (such as intermittent forgetfulness, feeling “hazy” and difficulty concentrating). It may cause a disruption of normal bodily systems function leading to cardiovascular diseases, diabetes and hormone regulation [4]. Cohort studies have demonstrated stress as a risk factor for declining physical function and obesity [5].

Although the workplace cannot replace all aspects of an individual’s health, working hours, sleep recovery, mental health support and coping skills are modifiable health risks that could be addressed at the workplace and thus, improve an individual’s reaction to ongoing stressors.

Areas to offer healthy worksites

A goal of Healthy People 2030 was to increase the proportion of worksites that offered an employee health promotion program, including physical activity, nutrition and smoking bans [6]. The EMS workforce is vital to the health of the community, but it lacks sufficient resources to keep its personnel healthy. While there are many studies about the association between occupational stress and poor overall health outcomes, only recently has workplace support been offered as a solution to help employees.

In general, workplaces that have established health promotion programs tend to have higher levels of retention and employee satisfaction [7]. As EMS personnel are potentially exposed to repeated stressors in their work environments, the workplace is already an effective place to emphasize support practices and personnel safety. An effective workplace intervention strategy could provide an opportunity to support EMS personnel to address their health outcomes and provide early access to mental health materials. In 2016, NAEMT’s National Survey on EMS Mental Health Services found that 37% of EMS agencies provided mental health support for EMS practitioners, and only 55% of EMS agencies provided health and wellness services in general [8].

Work-related stress, such as heavy workload and unstable working conditions, can exacerbate stress-related outcomes. Overworking was one of the most reported causes of burnout and stress with EMS personnel. In 2016, the median weekly work hours for an EMT-Basic was 48.1 hours and 51.8 hours for EMT-Paramedics [8,9].

Additionally, people in industries that require long shift hours are at a higher risk for sleep-related disorders or short sleep duration [10]. Specifically, half of EMS employees sleep only 6 hours every 24 hours, with more than half reporting poor sleep quality and 70% reporting some problems with sleep [11,12]. If an EMT works multiple jobs, their sleep may be further challenged, which could affect job performance. If EMS personnel continue to work with an unaddressed sleep-wake disorder, they may pose an increased work hazard [11,12].

For workplace sleep interventions, identifying and treating sleep disorders may fall on the individual, but workplace health promotion teams can promote healthy sleep practices and resources such as insurance coverage for weight loss programs for sleep apnea, coverage of sleep specialists, and opportunities to de-stress or process emotions about traumatic exposures.

Why is this important

Literature has demonstrated that worksite health promotion programs aimed at improving physical and mental health help reduce costs associated with job trainings and medical costs for employees [13]. EMS agencies who invest in low-budget screenings and wellness programs are also investing in their employees to work longer and healthier (without burnout, fatigue and mental health complications).

Also, addressing burnout and building social support networks could help workforce retention. Riolli et al. found that psychological resilience mediated the relationship between stress, psychosocial wellness, and physical well-being [14]. In a similar study, high levels of coping skills were associated with increased evidence of mental stress but a more stable health outcome. A combination of resilience, hope, self-efficacy, and optimism enhanced coping and safeguarded health [15].

Conclusion and recommendations

EMS have a low utilization of referrals and ongoing follow ups to mental health providers due to time constraints and stigma to seek support from counseling (EAPA, 2014). Organizations that have addressed their current workplace wellness gaps and provided better resources to address sleep recovery and stress management.

Fortunately, telemedicine is becoming more widely available. In 2019, there were 146 agencies offering telehealth within Georgia [16]. Given the personnel’s busy work schedules, agencies that partner with mental health practitioners and offer telehealth services may be an effective solution to bring mental health aid to EMS personnel.

ABOUT THE AUTHORS

Carlene Robinson, DrPH, MPH, (she/they) is an epidemiologist studying clinical and translational health, specifically in mental health epidemiology. She has 5 years of 911 and transport experience within EMS systems. Collectively, Dr. Robinson has 8 years of experience in research, education and consulting with agencies.

Kelly Sullivan, PhD, FACE, is an associate professor at Georgia Southern University. She specializes in neuroepidemiology, sleep disorders and mental health.

Jessica Schwind, PhD, is the director of the Institute for Health Logistics and Analytics at Georgia Southern University. She specializes in emergency preparedness and rural epidemiology.

Andrew Hansen, DrPH, is a professor at Georgia Southern University. He specializes in health and wellness related to behavior, environmental and structural influences.

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