Mental Health Challenges for EMTs in Alberta

Emergency Medical Technicians (EMTs) in Alberta are heroes who provide crucial care in emergencies. However, this demanding job exposes them to many stressful situations that can affect their EMT mental well-being. This article explores the mental health challenges faced by Alberta’s EMTs, focusing on the problems, how they’ve been addressed over time, current support systems, and how to spot warning signs.

The Challenges of Being an EMT: Stressors of the Job

Being an EMT is a stressful job with many different challenges that can impact an EMT’s mental health.

• Seeing Traumatic Events: EMTs are often the first to arrive at accidents, medical emergencies, and violent incidents. They regularly see things that most people would find very upsetting: serious injuries, death, and people suffering. This constant exposure to trauma can lead to psychological issues like post-traumatic stress disorder (PTSD), acute stress disorder, and anxiety. The emotional impact of caring for people in life-or-death situations adds a significant burden. For more information, see this article on JEMS.
• Shift Work Disruptions: EMTs often work long and irregular hours, including nights, weekends, and holidays. This irregular schedule disrupts their body’s natural sleep-wake cycle (circadian rhythm), leading to sleep deprivation, tiredness, and increased stress. Long-term sleep problems have been linked to depression, anxiety, and reduced mental sharpness. The lack of a regular routine can also make it hard to maintain healthy relationships and personal life, adding extra stress.
• High-Pressure Decisions: EMTs frequently have to make critical, life-or-death decisions under immense pressure. They must quickly assess patients, decide on treatment, and provide care, often with limited information. The weight of these decisions, knowing that a mistake could have terrible consequences, creates a significant mental burden. This constant pressure can contribute to anxiety, stress, and EMT burnout.
• Dealing with Distressed People: EMTs interact with patients and families during times of extreme stress. Dealing with scared, grieving, or even aggressive individuals can be emotionally draining. EMTs must provide comfort and support while managing their own emotional reactions. This constant need to handle the emotions of crisis situations can lead to compassion fatigue.
• Normal Stress vs. Mental Health Concerns: There is a clear difference between normal stress and mental health issues. Normal stress might cause temporary anxiety, difficulty sleeping, or sadness. Mental health support for EMTs becomes necessary when sadness and anxieties persist and begin showing up as intrusive thoughts, avoidance of certain places or actions, emotional detachment, and big changes in appetite.

Historical Context: From “Tough It Out” to Recognizing the Problem

How mental health in the EMT profession has been viewed and handled has changed significantly over time.

In the past, emergency services often had a culture of toughness and self-reliance. EMTs were expected to “tough it out” and hide any emotional distress. There was a stigma around admitting vulnerability or seeking help, with many fearing it would be seen as weakness. This lack of open discussion and support meant many EMTs suffered in silence.

Later, events outside of emergency services led to a better understanding of PTSD and mental health issues in war veterans. This increased awareness also led to greater recognition of the psychological effects of trauma on first responders.

During the 20th and 21st centuries, research began to document the wide range of mental health struggles that EMTs encounter. This research called for more resources and mental health support for EMTs.

The perspective began to shift with increasing recognition of the psychological toll of repeated exposure to trauma. Researchers documented the high rates of PTSD, depression, anxiety, and EMT burnout, showing that these were not weaknesses but predictable consequences of the job’s demands. This led to increased calls for resources, proactive intervention, and a more supportive approach to EMT mental health. A 2023 publication, which can be viewed here, discusses the relationship between stress, burnout, and physical health.

Current Trends: Focus on Prevention, Early Help, and Support

The industry is constantly changing, and with it, the best practices for taking care of EMT’s mental health. These include stress management education, resilience-building techniques, and awareness of symptoms in oneself and colleagues.

Available Support Systems:

1. Peer Support Programs: These programs are based on the idea that EMTs can often best support each other. Trained EMT peers provide a confidential space for colleagues to share experiences, discuss challenges, and receive emotional support.
2. Employee Assistance Programs (EAPs): EAPs are confidential services offered by many employers, including healthcare organizations and emergency service agencies. They provide resources like short-term counseling, referrals to mental health professionals, and other support services.
3. Critical Incident Stress Management (CISM): CISM is a structured approach to managing the psychological impact of traumatic events. It typically involves group discussions soon after an incident (debriefings) and shorter, less formal discussions (defusings). CISM aims to provide a safe space for EMTs to process their experiences, normalize their reactions, and learn coping strategies.
4. Professional Therapy: Access to mental health professionals specializing in trauma and first responder issues is essential. These therapists can diagnose and treat conditions like PTSD, anxiety and depression. They can provide evidence-based therapies, such as cognitive-behavioral therapy (CBT) or eye movement desensitization and reprocessing (EMDR).

Technology is also increasingly being used, such as mobile apps that offer self-assessment tools, mindfulness exercises, and stress reduction techniques. Telehealth platforms provide access to virtual therapy sessions, making it easier for EMTs to receive care.

Research studies have consistently shown that rates of PTSD, anxiety, and depression are higher in EMTs compared to the rest of the population. Further information on depression among EMTs and paramedics can be found through additional resources.

Recognizing the Signs: Indicators and Triggers

Identifying the signs of mental health struggles is crucial for early intervention and support. These indicators can be behavioral, emotional, cognitive, or physical.

• Behavioral Indicators:
  • Increased Irritability and Anger.
  • Social Withdrawal.
  • Changes in Substance Use.
  • Reckless Behavior.
  • Difficulty Concentrating.
  • Changes in Work Performance.
• Emotional Indicators:
  • Persistent Sadness.
  • Excessive Anxiety.
  • Emotional Numbness.
  • Feeling Overwhelmed.
  • Loss of Interest.
  • Guilt and Shame.
• Cognitive Indicators:
  • Intrusive Thoughts.
  • Nightmares and Flashbacks.
  • Memory Problems.
  • Negative Thoughts.
  • Suicidal Thoughts (These require immediate professional help).
• Physical Indicators:
  • Chronic Fatigue.
  • Sleep Disturbances.
  • Appetite Changes.
  • Physical Complaints (headaches, stomachaches, muscle tension).
  • Cardiovascular Changes (increased heart rate, palpitations).

Triggering Events and Cumulative Stress

Certain types of calls and events can act as specific triggers for mental health problems. These may include:

• Calls involving children, especially those with serious injuries or deaths.
• Multiple casualty incidents (MCIs) where the scale of the event is overwhelming.
• Incidents where a colleague is seriously injured or killed.
• Calls where the EMT feels personally threatened or is exposed to violence.
• Situations involving extreme human suffering or severe injuries.

It’s also important to recognize the impact of cumulative stress. The gradual buildup of stress from multiple calls over time, even if no single event is overtly traumatic, can take a significant toll. This can lead to EMT burnout, emotional exhaustion, and a decline in overall mental well-being.

Moral injury, distress from events that violate an EMT’s ethical code, may also occur. More information about moral injury can be found in this article.

Different Perspectives: Navigating the Issues

Within the field of EMT mental health, there are ongoing discussions and different viewpoints on several key issues.

Organizational Leadership

Organizational leadership plays a critical role in creating a culture that supports EMT mental health. This involves:

• Creating a Supportive Environment: Fostering a workplace where seeking help is encouraged, where mental health is openly discussed, and where EMTs feel safe to express their vulnerabilities.
• Providing Resources: Ensuring resources are available, including access to EAPs, peer support, CISM, and professional therapy.
• Reducing Stigma: Actively working to reduce the stigma associated with mental health issues through education and awareness campaigns.
• Encouraging Help-Seeking: Promoting a proactive approach to mental health, where EMTs are encouraged to seek help early.

Mandatory Mental Health Screenings

The idea of mandatory mental health screenings for EMTs is debated.

• Arguments in Favor: Supporters argue that mandatory screenings can help identify EMTs who are struggling but may not be aware of their symptoms or may be reluctant to seek help.
• Arguments Against: Opponents raise concerns about privacy, the potential for stigma, and the possibility of misuse of screening results.

Stigma: A Significant Barrier

Stigma remains a major obstacle to EMTs seeking help. Strategies to combat stigma include:

• Peer Support: Peer support programs can be effective, as EMTs are often more comfortable talking to colleagues.
• Open Communication: Encouraging open conversations about mental health can help normalize the issue.
• Leadership Modeling: When leaders are open about their own mental health experiences or promote mental health initiatives, it sends a powerful message.
• Education: Providing education about mental health conditions can help dispel myths.

Ethics

Confidentiality is a large, ethical, issue for EMTs seeking mental health help. EMTs have expressed that they might be hesitant to use EAP services or workplace resources if they believe it will negatively affect their career. Further information surrounding this can be found in this article.

The Alberta Context: Specific Resources and Initiatives

In Alberta, there are unique resources and initiatives aimed at supporting EMT mental health. You can find more information about Alberta EMT mental health support through local programs.

Canada: A National Framework

• National Standard: The Mental Health Commission of Canada has developed the National Standard for Psychological Health and Safety in the Workplace.
• National Organizations: Organizations like the Canadian Mental Health Association (CMHA) and the Paramedic Association of Canada offer resources and support.
• Provincial Initiatives: Many provinces have implemented specific programs to support first responder mental health.

Alberta: A Focus on First Responders

• Alberta Health Services (AHS): AHS provides Employee and Family Assistance Program (EFAP) services to its employees, including EMTs.
• Alberta Paramedic Association: The Alberta Paramedic Association actively advocates for the mental health needs of its members.
• HiMARC: The “Heroes in Mind, Advocacy and Research Consortium” (HiMARC) is an Alberta-based organization. It conducts research, develops resources, and provides training specifically focused on the mental health of first responders, including EMTs.
• Statistics: A 2021 publication reports that of the Albertan paramedics sampled, 32.5% dealt with extreme anxiety, and 16% had been previously diagnosed with PTSD. You can view this publication here.
• Legislation: Alberta has taken significant legislative steps to support first responders, including presumptive coverage for PTSD in first responders
  • Bill 1 (Workers’ Compensation Amendment Act): Introduced presumptive coverage for PTSD for first responders, making it easier to access workers’ compensation benefits.
  • Bill 37 (Workers’ Compensation Amendment Act, 2018): Expanded presumptive coverage beyond PTSD to include other psychological injuries. Further information about the bills can be read here.

Next Steps with Responders First

The mental health challenges faced by EMTs are significant. The nature of the job creates a unique set of stressors. While progress has been made in recognizing and addressing these challenges, ongoing efforts are essential. In Alberta, valuable resources and legislative measures are in place, but continued advocacy and commitment are needed to ensure that EMTs receive the mental health support for EMTs that they deserve. If you are an EMT in Alberta and are struggling, reach out to Responders First. We are here to provide the support and resources you need to prioritize your mental well-being.

Don Davis

15+ years of emergency response experience. Passionate about connecting our first responder communities with critical resources. Author of hundreds of articles and guides on First Responders mental health care. When not responding to emergencies, you can find me playing with my dogs, hiking, or enjoying a good book.