Reality check: The female EMS experience

By Molly McCann-Pineo, PhD, MS

Historically, EMS has been a field dominated by men. Over the last 10 years, however, more women have become EMS clinicians and now comprise 31% of the workforce [1]. Attracting and retaining female clinicians is vital to the success of EMS: ample data demonstrates that patient outcomes improve when clinicians reflect the communities they serve [2-7].

Still, the EMS workforce remains highly skewed male. To attenuate the current gender disparities in the EMS workforce, we must first invest in research to understand the full scope of the problem to make evidence-backed policy recommendations. We present a first step towards this research with our paper, “The Female Emergency Service Provider Experience: A Mixed Methods Study.”

Burnout, PTSD risk in EMS clinicians

First responding occupations, including EMS, are associated with adverse psychological outcomes, largely due to repetitive and frequent exposure to traumatic scenarios. These outcomes, including posttraumatic stress disorder (PTSD), anxiety, depression, substance use, sleep disturbances and burnout, are markedly elevated among these occupational cohorts [8-14].

Among EMS providers specifically, recent estimates of anxiety and depression have been reported at upwards of 28% and 37%, respectively [15]. Post-pandemic PTSD affects between 11% and 28% of EMS clinicians, more than double that of the general population [15]. Further, nearly 70% of paramedics report burnout [16, 17]. Estimates among frontline physicians and nurses (35-43%) and firefighters (19-23%) are considerably lower [19,20].

Women are at elevated risk for negative mental health outcomes, including those listed above [21-24]. Further, women experience unique stressors in the workplace compared to men, including lack of pregnancy and other familial accommodations, harassment and discrimination [25, 26]. The data tentatively show that the behavioral health risk of being female and of being an EMS clinician is additive [27-31].

Yet, much of the current literature regarding gendered disparities in female occupational and personal wellbeing are discussed among other first responding cohorts, rather than EMS [27, 31-33] This paucity of knowledge is what prompted our study, which showed how the occupational experiences and stressors experienced among female EMS clinicians impact their well-being.

The female EMS clinician experience

We conducted a mixed methods study consisting of three qualitative focus group sessions and a cross-sectional self-report survey. Female EMS clinicians were recruited from primarily northeastern EMS agencies in the U.S. for participation in the focus group sessions. Twenty-two women participated across three focus groups. Each session was recorded and analyzed to identify themes and subthemes that characterized the female EMS clinician experience. From our focus group sessions, the most concerning themes included [34]:

• Sexism and harassment
• Lack of pregnancy and maternity accommodations
• Lack of career advancement opportunities
• Lack of organizational support

To contextualize these findings, we recruited female EMS clinicians to participate in a one-time, self-report survey inquiring about their perceptions and overall experiences. A total of 161 women participated in the survey, with a median age of 32 years. The majority were white (88.6%) [34]. The median years of clinical experience as an EMS clinician was 7 years, and over half were certified/licensed as EMT-Bs (55.1%).

Globally, sexism and harassment were the most frequently discussed topic. We found that over 70% of participants reported experiencing sexism (76%) or some form of harassment (verbal, physical and sexual, 72%). The majority reported verbal harassment, but female EMS clinicians also report experiencing physical and sexual harassment in high proportions. While much of this harassment was from patients, fellow EMS partners and coworkers also contributed. These findings are on par with what has been found in female firefighting populations [32, 35, 36].

Pregnancy and maternity related concerns also featured heavily. Given the improvements in federal and state protections and accommodations for pregnant employees, including the recent passing of the Pregnancy Workers Fairness Act in 2023, the experiences our respondents reported indicate that implementing these laws in an EMS context may require further governmental funding and support [37]. For instance, clinicians brought up job-related miscarriage and delayed family on numerous occasions in our study [34]. Study participants described extreme difficulty in obtaining less physically dangerous or demanding positions on the team [34]. For context, imagine having a high-risk pregnancy where your physician has recommended light duty, yet you cannot obtain such a position without risking your job or financial security.

However, ensuring light duty positions for all pregnant clinicians is simply not an option at many EMS agencies. These positions typically exist on a “first come, first serve” basis, and are shared with other groups of clinicians, such as those injured while on duty. Further, the process to obtain such a position is administratively burdensome, and sometimes denied. This leaves many female clinicians faced with going on leave prematurely, frequently without pay, generating significant financial hardships. Almost half of our survey participants who reported a pregnancy reported having to take a leave of absence earlier than anticipated, citing medical necessity and unavailability light duty positions as the primary reasons.

Understanding gender disparities

While our study provided a clear signal that further investigation is needed, researchers currently have a limited understanding of the scope of gendered disparities in the EMS workforce, which limits our ability to make firm policy recommendations. The first actionable step is therefore to undertake extensive, rigorous study of the problem on both a national and local scale. This takes time, however, and the field should simultaneously consider the low-hanging fruit revealed by our study:

• Properly fitted uniforms
• Secured light-duty positions for pregnant clinicians
• Harassment and discrimination training and resources for those affected
• Training and psychoeducation on emotional awareness and regulation to reduce mental health stigma
• More educational opportunities for physicians who wish to specialize in caring for this population

Future work should endeavor to secure a geographically and racially representative sample, to determine whether and how urban versus rural EMS effects gendered disparities among this workforce and whether and how race and gender interact to affect the well-being and safety of clinicians.

Further, understanding the role of volunteer versus career status may provide insight whether volunteer status is a confounding or compounding factor for gendered experiences of EMS service, as women are more likely than men to volunteer for EMS [38]. Recent hypotheses surrounding this concept suggest that clinicians of volunteer status may experience more mental and behavioral health burdens due to unfixed scheduling, availability of health care benefits and resources and limited camaraderie with peers [39-41].

In closing, the female EMS clinicians in our study find it as an inherently worthy occupation. Despite their challenges, these clinicians continue to show up for their communities, providing the highest levels of care. We all benefit from their inclusion, so it should a national priority to create safe, healthy and supportive working environments [42, 43].

ABOUT THE AUTHOR
Dr. Molly McCann-Pineo is director of clinical research, Emergency Medicine Service Line, at Northwell Health; and assistant professor of emergency medicine and occupational medicine, epidemiology and prevention, for the Zucker School of Medicine at Hofstra/Northwell, in Uniondale, New York.

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