The Project Team

As part of the February 2015 Ambulance Service Manager (ASM) class, seven of us were randomly assigned to groups and asked to complete a project in ten weeks with team members spread across the United States. Our research we presented our data to the ASM class as part of the requirements for graduation.

All told, the seven members of our group have a combined total of 92 years of service in EMS. Many started as EMTs and worked up to Paramedic status, some began as volunteers, and the rest came to EMS as a second career. Nonetheless, we are all driven by ambitious personalities, our ability to make a difference, our desire to provide meaningful patient care, and the opportunity to work with other public service providers. The group consists of the following people:

• Amy Young—BBA, Critical Care Paramedic, Director of Ground Operations West at CareFlite, Texas
• Chad Newland—Paramedic, Deputy Operations Manager for the Contra Costa County division of AMR, California
• Monique Rose—Critical Care Paramedic, Captain with Humboldt General Hospital EMS Rescue and function predominately within the Special Operations Division, Nevada
• Erich Barber—NREMT, Captain for Grand County EMS, Colorado
• John Harvey—Flight Paramedic, Battalion Chief with Miami County EMS, Kansas
• Cord Abbott—Paramedic Shift Commander, Montgomery County Hospital District, Texas
• Brian Burke, Sr.—Paramedic, Administrative Supervisor for Bay Cities Ambulance, Oregon

Our group decided on a topic that was both personal and something we hoped could make a significant impact on the EMS culture. We chose to do a survey about the prevalence of critical stress amongst EMS and evaluate why suicide rates of EMS providers is on the rise.

The Shocking Survey Results

[quote_left]37% of providers across the nation who responded to our survey had contemplated suicide, and 6.6% of those respondents have actually attempted to take their own lives.[/quote_left]Our EMS specific-survey was open for 40 days, resulting in 4,022 responses from all 50 United States plus Guam, the District of Columbia, American Samoa, and Puerto Rico. When we closed the survey, we were hit with a hard reality: that EMS suicide numbers were skyrocketing and the programs available to help were not sufficient. Our data shows that 1,383 of the 4,022 (37%) providers across the nation who responded to our survey had contemplated suicide, and 6.6% of those respondents have actually attempted to take their own lives.

The survey data shows that respondents working in an EMS culture that does not support the mental wellness and does not encourage the use of formal support institutions like Employee Assistance Programs (EAPs) and Critical Incident Stress Management (CISM) are substantially more likely to contemplate and/or attempt suicide. Additionally, respondents that don’t come from an EMS culture of support and encouragement are much less likely to seek help when they need it, and are much less likely to engage in helpful support.

The also survey measured the effectiveness of formal support institutions like EAPs and CISM. The results startlingly showed that these support institutions were rated as being either “Very Helpful” or “Extremely Helpful” by the respondents that use them. After hearing so many stories about how inept an EAP counselor was or what a “waste of time” that CISM session turned out to be, we expected these numbers to be much, much lower.

In other words, we discovered a very significant prevalence of suicidal ideation in the EMS provider community. We discovered that EAPs and CISM have room for improvement, but do not fall as short of the mark as we originally perceived. It appears, however, that a very significant component to the prevalence and severity of stress in the EMS culture to include suicidal ideation and attempt is the EMS culture itself.

For us, these results brought a whole new meaning to the project. We named our team Reviving Responders, because we realized we need to revive ourselves if want to continue reviving others. A few group members had even experienced suicide by fellow associates in their organizations. [Team member] Monique Rose said, “I was exposed to this issue following a close call involving the resuscitation of the guys in my department. During this time our department struggled to process the tragedy, and I became aware of the flaws in the system while working through some of my own demons.”

CDC. (2012). www.cdc.gov. Retrieved from Centers for Disease Control and Prevention.

How You Can Help

First and foremost, recognition and acknowledgement. As leaders, we cannot afford to be timid about this. If we see one of our own in distress, we must step out of our comfort zone and have the difficult conversations. It will be hard. This is a very dominant and proud profession, and we may not have our staff lining up to say they are struggling. Leaders need tolearn to recognize the warning signs and say something before it’s too late. Really, it should be the responsibility of every single person in EMS to notice subtle changes in individual behavior or work ethics.

Second, employers must be supportive, and offer an environment that supports employee well-being and mental health.

Last, employers should help change the culture of EMS across the board by providing the appropriate resources and ensuring they are available all the time and for as long as the service is needed.

How the Ambulance Industry Can Help

[quote_right]There is no question that field providers are not inherently equipped to deal with the stressors of the profession.[/quote_right] The ambulance industry needs to own the fact that we do not have adequate culture of support for providers to deal with suicide. There is no question that field providers are not inherently equipped to deal with the stressors of the profession. Coping skills for these stressors need to be taught to providers, and providers need to realize that receiving assistance with those skills is acceptable. The irony of the matter here is that many cultures in the industry are in direct opposition to the idea of getting help to deal with the stressors in EMS. As industry leaders, we are responsible for the tone of our respective divisions, and as such have the ability to steer culture. Our data suggests that taking steps to move culture towards one of support for providers’ mental well-being will be far more effective than attempting to reform the current state of CISM and EAP.

With projects like Reviving Responders and ASM, the word is spreading quickly. If we shift the culture, we can reduce the stigma that surrounds this topic. Think about it this way—if we can’t take care of our providers, how do you expect them to take care of patients? As an industry, we must be serious and promote access to various types of resources as no single type will work for everyone.

Most importantly, we must expand our education curriculum to include acknowledgment, recognition, and coping mechanisms far beyond the current single chapter “well-being of the provider” in all our literature.

Final Thoughts

Please speak up so we can help. Reviving Responders is our group’s effort to continue working towards a solution. Right now we are partnering with multiple entities around the U.S. to compile a list of suitable resources tailored to EMS and public safety as a whole. We hope that by sharing our stories others will be encouraged to speak up.

One great resource is Safe Call Now, 206-459-3020, which provides a confidential 24-hour crisis referral service. Safe Call Now allows public safety employees to speak with mental health professionals that are familiar with our line of work , as well as  public safety professionals who understand and can relate. We have more resources available on our website, www.revivingresponders.com..