EMS Week 2023: Prioritizing Provider Health
In the fast-paced and challenging field of emergency medical services, provider well-being often takes a backseat to the urgent needs of those they serve. However, recognizing the importance of EMS provider health and wellness is crucial. As the demands on EMS professionals continue to evolve and intensify, it is imperative to acknowledge the significant impact that physical, mental, and emotional well-being can have on their ability to provide exceptional care. In honor of EMS Week 2023, here are some of the data points and benchmarks driving change in provider health and wellness.
In 2023, there were 5,045 critical incidents reported from EMS clinicians at 297 different agencies in ESO EHR. The critical incident component reports on 9 circumstances to collectively represent potentially psychologically traumatizing events on EMS providers, including events like:
- Serious injury or line of duty death
- Suicide of a co-worker
- Death or serious injury to a child
- Multi-casualty incident or disaster
- Victim is known to the responder
- Any incident where personal safety of the responder is jeopardized
- Incidents with excessive media interest
- Any incident with unusually strong emotional components.
Underreporting critical incidents, access to proper training, and addressing the stigma around mental health are important considerations. To prioritize provider mental health in these incidents, see the list of the recommendations in 2023 EMS Index which includes advice on organizational culture, follow-up activities, mental health resources, and more.
According to the recently presented abstract at the NAEMSP Annual Conference, Emergency Medical Services Clinicians Are Increasingly Exposed to Death (Breyre, Crowe, et al.), from 2018 to 2021, EMS clinicians were increasingly exposed to death and opportunities to deliver death notifications. This study was not designed to evaluate the causes of death, but undoubtedly the COVID pandemic and associated changes in our healthcare system have contributed to this increase in out-of-hospital death encountered by EMS.
While the benefits of on-scene termination of resuscitation are well-established, exposure to death and communicating death notifications are linked to increased burnout among EMS clinicians. Notifying a family of the death of a loved one can be a challenging and stressful for providers. Fortunately, formal training in death communication has proven to reduce the stress related to such notifications; EMS providers and agencies are encouraged to take advantage of educational opportunities.
The Research: Link to research report
Workplace Violence and Safety
The research team behind the 2019 NASEMSO abstract, North Carolina EMS Providers’ Experiences and Attitudes Regarding Workplace Violence and Safety, assessed the proportion of EMS providers in North Carolina who reported one or more forms of assault while on duty in the prior 24 months, and identified demographic and work-related factors. The EMS providers’ attitudes regarding workplace safety and management of workplace assaults events were also examined.
The results? More than two-thirds of respondents indicated they had been physically or verbally assaulted while on duty in the last 24 months. Those who reported an assault in the last 24 months felt less safe at work and less able to manage physical violence.
And though more than 66% of respondents indicated they had experienced assault, there was also an increase in perceived ability to manage violence by those who had not experienced violence. Potentially, this indicates providers may be overconfident or unaware of potential threats in this area.
The Research: Link to full abstract
EMS Workforce Longevity
An abstract released at NASEMSO 2019 described a study exploring the length of time EMS providers in South Carolina remain in the workforce using ESO’s state repository data. The study looked at all EMS providers who held an EMS certification in South Carolina from 1970 to 2019.
The study concluded that a large number of respondents renewed their EMS certification only once before leaving the field of EMS in South Carolina. Almost three-quarters of the South Carolina EMS workforce maintained their EMS certification for less than 8 years, more than 90% don’t make it to 20 years of service, and more than 98% do not accumulate enough service time to retire from EMS. Females maintained EMS certification for fewer years compared to males. And EMTs maintain certification for fewer years compared to paramedics.
First responder retention and recruitment strategies are still top of mind in 2023. Many of the reasons already listed above – like workplace safety and stress – contribute to this longevity.
The Research: Link to full abstract
Burnout has long been linked to negative workplace-level effects. However, typically studies have primarily focused on individuals rather than job-related characteristics. The association of job demands and resources with burnout among emergency medical services professionals (Crowe, Fernandez, et al. ) sought to not only evaluate variation in burnout between agencies, but also quantify the relationship between burnout and job-related demands/resources among EMS professionals.
The proportion of EMS professionals experiencing burnout varied substantially. Out of 1,271 EMS professionals working at 248 EMS agencies, the median agency-level burnout was 35%. But the trends may not surprise you:
- Job-related demands, including time pressure, were associated with increased burnout.
- Traditional job-related resources, including improved pay and benefits, were associated with reduced burnout.
- Less tangible job resources, including autonomy, clinical performance feedback, social support, and adequate training demonstrated strong associations with reduced burnout.
The takeaway here is that high job demands and low job resources meant nearly a 10-fold increase in odds of burnout compared with those exposed to low demands and high resources. Employee resources, along with appropriate wages and benefits could go a long way in helping to reduce burnout in this profession.
The Research: PDF of full manuscript
Finally, in addition to the research and information above, here are a few resources we recommend:
- About Death Notifications
- About Mental Health Resources – for IAFF members
- About Burnout Prevention and Best Practices
It’s no secret: The role an EMS professional takes on every day is risky and taxing, and we have to acknowledge the significant impact the job takes – in physical, mental, and emotional ways. At ESO, we hope to continue to provide research, benchmarks, and best practices for how we can improve provider well-being and safety across the industry. Without our EMS professionals, all of our safety would be at risk.