Stress Lurks as a Silent Killer Among 1st Responders

Source: Aidan Bartos - unsplash

According to an article published in the LA Times, currently, the average career span of an EMT or paramedic is only five years. This is due in part to burnout and stress and in part to the job’s physical toll.

Documented suicides among first responders have been rising since around 2005 and exceeded 100 each year from 2014 to 2017, according to the Firefighter Behavioral Health Alliance, with 115 cases in 2017 alone.

More firefighters took their own lives than died on the job over that span, though line-of-duty deaths often eclipse suicides in the media and public consciousness.

The suicide rate among such workers has been estimated at 18 per 100,000 people, exceeding the rate in the general population of 13 per 100,000, according to a report by the Ruderman Family Foundation and federal data.

EMS World reports that on a daily basis, firefighters, police, and emergency medical workers are all exposed to the risks of seeing death and destruction.

Divorce rates are growing. Burnout must be addressed, as well as long hours. New solutions must be proposed and evaluated.

The article goes on to say that paramedics as young as 19 years old work on advanced life support ambulances. Studies have shown the human brain does not fully mature until age 25. A crew on an EMS shift may run multiple calls during a single shift, where they may be responsible for pronouncing patients deceased.

A 19-year-old provider could respond to a decapitated body on a roadway or enter a home in which an infant is dead in its crib.

After making the pronouncement and breaking the news to the family, their next call may be for someone who claims to have back pain but just wants to be medicated. This is where the stress begins.

The high potential for serious injury in EMS is also a stressor.

In 2014 the Bureau of Labor Statistics reported the overall injury rate for EMTs and paramedics was 333 injuries per 10,000 workers—more than three times higher than the average rate of 107 for all occupational groups in the U.S.

According to one national survey of more than 1,000 firefighters, nearly half reported having suicidal thoughts. One in five reported planning a suicide.

The EMSWorld article shows that burnout, no sleep, low nutrition, and fatigue comprise a recipe for post-traumatic stress disorder, prevalent in the emergency services.

For many reasons, first responders hold it in, don’t ask for help and only when they get home, it seems do they let off steam, often to the detriment of the family.

Dr Stephen Odom, CEO of Vista Health, says “They hear everything and see everything, it’s the worst moments in people’s lives and they’re supposed to be calm and handle it.”

Much of the time, first responders feel they can’t reveal their feelings to co-workers or management for fear that they might be considered weak or lose out on a promotion.

Often, there is a code of silence about such issues at work and the fear of reprisal.

Many services implement critical incident stress debriefings (CISD). These are aimed at helping individuals contextualize their experience of trauma at an early stage, thus preventing the development of PTSD. 

CISD is for all services and is recommended to be held no longer than 72 hours after the incident.

This meeting will allow each person on scene to discuss their feelings openly with no judgment. There is a professional present for reassurance of skills performed on scene and general handling of the situation.

Emergency services have come a long way in a short time in this country. However, many issues still need to be worked out, particularly concerning the well-being of our first responders.