EMTs and paramedics experience PTSD and depression at higher rates than the general population. Experts say it’s up to employers to get them help.
Thousands of emergency medical technicians and paramedics are on the front lines of disasters, accidents, and potentially deadly circumstances every day. Caleb Henry was one of them until he quit his job in 2018 because of the constant barrage of trauma he witnessed on the job in California.
“There are calls that I do not forget,” Henry told HuffPost. “There are calls that I still think about.”
The 21-year-old former EMT has been diagnosed with depression, anxiety and PTSD. After a couple of years of long workdays and nightmarish memories from on-the-job horrors with zero in-house health resources, Henry said the work took a toll on his mental health.
“A 14-year-old girl was walking on the tracks, listening to music and was hit by the train,” Henry said, recalling one assignment that still haunts him. “She was losing a lot of blood. We did all we could. She died en route to the hospital.”
Long afterward, he said, he found himself “replaying the scene in my mind, obsessively.”
“I can’t go near a train track,” he said. “It really triggers me.”
In this profession, mental illness is common. EMTs and paramedics experience higher rates of PTSD, major depression, substance abuse and suicide than the general population, according to scientific studies in the U.S. and England. This high-stress career path also holds increased risks of physical health problems and complications.
First responders can run on little sleep during long shifts, faced with graphic scenes and little time “to stop and breathe,” according to Henry. The pressure of life and death hangs over every action.
“As much as a therapist could tell you that you’re not responsible for someone’s death … that is your patient,” Henry said. “You’re making the decisions. They’re your patients. Was it something that I did? Did I make a wrong decision? Did we take too long? There is that responsibility.”
Despite the physical and mental toll of the job, paramedics and EMTs don’t always earn as much as other first responders. Many paramedics juggle multiple jobs because of low pay ― an average of $16.50 an hour in 2018, according to the Bureau of Labor Statistics. That’s 40% less than what the average American earned, Money magazine reported.
In New York City, for example, they lag behind firefighters in pay and benefits, according to a New York Times editorial published in September.
As that suggests, the first responder pecking order often leaves EMTs and paramedics overshadowed by police officers and firefighters. In July, President Donald Trump allocated $7.5 million annually for five years for mental health services for police officers, but nothing for paramedics, EMTs or firefighters.
Parts of the brain may not store memories after an emotional or shocking event, said Stephanie Conn, a licensed psychologist who founded First Responder Psychology in Oregon. People may not remember details correctly, or they may feel like the event is ongoing — resending and replaying terrifying images over and over. The amygdala, the region of the brain associated with emotional processes, goes into hyperdrive. Adrenaline makes the images more vivid and frightening. And brain scans show the hippocampus, associated with memory formation, shrinks with chronic exposure to trauma.
Regular exposure compounds the problems.
“It keeps sending them those images when they’re asleep, in their waking hours,” Conn said. “When they go home to see their kid at the end of the shift, they’ll see the face of the kid that died in an accident earlier that day.”
The traumatized brain, she continued, “starts to see danger even when it doesn’t exist. Certain parts of the brain shrink — it’s like a muscle — and it will create more problems if [the hippocampus] keeps getting shut down.”
Conn knows the pressures of being a first responder well. She was a police officer for nine years, has been married to a cop for about 20 years, and her father was an officer for 40 years. She saw a gap in mental health care available to first responders and decided to fill it.
Conn’s First Responder Psychology offers trauma-informed training for organizations that teaches how to develop healthy habits. It includes work-life balance guidance and coaching on how to begin and lead peer support programs. Employees can learn how to beat burnout and traumatic stress, and employers are taught how to address these issues by adopting proactive and reactive strategies to take care of workers.
The first responder advocacy group Code Green Campaign also casts the mental health crisis as a fixable problem that is the responsibility of employers.
Ann Marie Farina, the co-founder of the Code Green Campaign, worked in many roles in emergency medicine, including paramedic, a wildfire medic, and a volunteer firefighter. After confiding in other first responders after the suicide of a co-worker, Farina said she realized many of her counterparts have had friends and co-workers who’ve died by suicide.
“There is no way this is a coincidence,” Farina told herself.
Farina’s organization counsels emergency response groups on keeping their employees healthy, and advises them how to prevent suicide and handle “postvention” in the case of a suicide attempt.
Code Green argues that employers must make sure resources are culturally aware, affordable and easily accessible. Without ways to manage the unique demands of the job, Farina said of paramedics and EMTs, “they’re gonna be burned out and then they’re gonna quit.”
As an EMT, Henry remembers how he was unable to show his emotions or honest reactions to a traumatic scene, on the job or afterward. Though he did seek comfort talking with co-workers, he didn’t totally feel supported in the work environment.
“Showing any sign of weakness, you’re gonna get berated for it,” Henry said. “You’re gonna get shut down.”
The way to fix a broken cycle of deteriorating mental health, Farina said, is for EMS agencies to reduce the stigma around mental illness, and provide education and support in recognizing and addressing the signs and symptoms of problems. Learning and talking, she said, are vital to changing a culture often discourages both.
“Helping the managers talk to employees in a way that is meaningful and actually productive — that’s something we’ve looked into for stigma reduction,” she said. “When we talk about wanting to break the stigma down, we want to be a voice for people and bridge the gap between the field employees and management.”