Trauma Takes Its Toll: Addressing the Mental Health Crisis in Emergency Services

By Fitch, Jay; Marshall, Jim | Public Management, May 2016 | Go to article overview

Trauma Takes Its Toll: Addressing the Mental Health Crisis in Emergency Services


Fitch, Jay, Marshall, Jim, Public Management


Amidst growing concern about the mental health of emergency medical service (EMS) professionals, a Fitch & Associates' Ambulance Service Manager Program project team surveyed more than 4,000 EMS and fire professionals in 2015 about critical stress, suicide, and available support and resources. (1)

The results were stark.

Among survey respondents, 37 percent reported contemplating suicide--nearly 10 times the overall rate among American adults. (2) Additionally, 6.6 percent of survey respondents had attempted suicide, compared to just 0.5 percent of adults nationally.

Mental health issues are not limited to the EMS workforce. According to the Firefighter Behavioral Health Alliance, at least 759 firefighters have committed suicide since 2012. (3) In law enforcement, estimates suggest between 125 and 300 police officers commit suicide every year. (4,5)

These numbers should be a wakeup call, not only for every emergency medical technician (EMT), paramedic, firefighter, police officer, and emergency telecommunicator (sometimes called dispatchers or call-takers), but also for agency leaders and county and city officials who work with them.

Let's take a moment to pause here. How many brave and talented people are in your community--from those who answer the 911 calls to the EMTs, firefighters, and police who respond to them? Perhaps 20? 50? 500?

Now do the math. With these numbers, the survey findings would suggest that perhaps 7, or 18, or even 185 people on your team have thought about suicide.

One or more of them may have already attempted suicide or could in the future. Do you know who they are? Do you know how to help?

To address this mental health crisis in emergency services, industry leaders must join together to further define the problem, explore its causes, and pursue strategic planning to protect and equip the workforce.

The Traumatic Stress Factor

There is almost certainly a correlation between the impact of traumatic stress and the extraordinary statistics on suicide seen in our survey and other research. When a responder experiences intense fear, horror, or helplessness in response to a scene at which someone experienced serious injury or death, he or she has been exposed to a traumatic event.

Some of the common reactions to traumatic events include anxiety, irritability, sleep disorders and fatigue, appetite changes, and withdrawal from friends and family. (6)

Acute stress disorder describes cases in which some or all of these symptoms are experienced for more than two days after the event, but not for longer than one month. Post-traumatic stress disorder (PTSD) is diagnosed when these symptoms persist for more than one month. (7)

On-the-job stress among emergency responders can also trigger the release of cortisol and other stress hormones. This stress response is normal--and helpful--but when it occurs too frequently without adequate rebalancing, it ups the risk for chronic stress response, which can lead to physical and mental disorders. (8)

Each person's response may differ. Leaders need to be vigilant in watching for signs of acute and post-traumatic stress disorders among their public safety personnel.

Emergency Dispatchers Also at Risk

Although many people both inside and outside of the EMS, fire, and law enforcement fields understand the inherent stress of responding to emergency scenes, often the stress on 911 dispatchers is greatly underestimated.

One study found that between 17 percent and 24 percent of telecommunicators reported symptoms consistent with PTSD; 24 percent reported symptoms consistent with major depression. (9)

Another study reported that more than 16 percent of telecommunicators experience symptoms of compassion fatigue--a combination of post-traumatic stress symptoms and burnout. (10)

Emergency dispatchers may experience some stressors unique to their position. …

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