Quite often I see some EMS news story come across the wire about how a paramedic neglected to care for a patient as they should, or delayed a response, or in extreme cases were involved in some sort of serious altercation resulting in the injury or a patient, a tech, or their partner.  With every story I read, I get more and more concerned about the state of EMS, and the people who are providing care.  

While none of the situations I’ve read about are excusable, I think it is our responsibility to find the root cause, or at least minimize the chance of these incidents repeating themselves.  Personally, I feel that while stress is not an excuse it is a huge factor.

As a community it is our responsibility to give each and every provider not only the access to the training that they need to best provide care but we need to police our own to make sure that every provider is fit enough to provide that care.

Recently I read a story about a paramedic who was arrested for assaulting a patient.  While there is no excuse for his actions I cannot help but wonder what signs and symptoms this medic showed prior to the incident occuring.  I am not talking about during that shift but more in the weeks and months leading up to it.  When did they start to turn?  When did their attitude really start to decline?  Most importantly, what did anyone do about it to try and turn this person around?

A lot of it points towards the question of “how busy is too busy?”  Of course one must also ask if this is the job for them, but the EMS industry is so  focused on a single mission which centers around getting people to the hospital.  While a typical day on the ambulance can offer a large variety of calls, the sheer volume and type of calls can certainly create a stressful environment.  As those days compound into weeks, weeks to months, and months to years, each individual day becomes a contributing factor towards what could eventually become a burnt out paramedic.

I have written about warning signs in the past, and I cannot stress the importance of recognizing those danger signs not only in ourselves but in those around us.  If you see someone who is getting near that breaking point who you think might be dangerous or do something dangerous.

As prehospital clinicians we are tasked every day with caring for patients.  While on that mission we must not lose sight of what is taught to each of us on the first night of EMT class: keeping ourselves safe.  Don’t be afraid to speak up when you think a colleague might be in trouble, and don’t be afraid to ask for help when you might need it.  Doing so might not just save your patients, it could also save yourself.


  1. This one is going to be quite politically incorrect but I agree that stress is one of the most important issues in the industry. So many of the other issues affecting EMS can at least be partially attributed to stress. The extreme turnover in the private EMS industry can be tied to stress as well as other issues that tie into it.

    The issue is much more severe in busy systems for a variety of reasons. There is definitely a point where the system is too busy. There is a fine line between efficiency in the business sense and working crews too hard. This issue is even worse in more urban areas where there is often the issues of many calls being of the non-emergent nature and a more challenging demographic. The lack of down time can lead crews to feel overwhelmed and this can cause a decrease in quality of care.

    In addition to the volume causing stress, there is the issue of pay. There is no immediate solution to the issue of compensation due to the variety of factors involved but it is definitely an issue. The lack of monetary compensation leads to personal financial concerns but also can lead to burnout in other ways. When EMS personnel in a busy system work excessive amounts of overtime, they are placed right back into the extremely stressful environment. Time off from any job is necessary in order to stay fresh and reduce stress. Working 70-80 hours per week in one of the most stressful, underpaid occupations is only sustainable for so long.

    This one could be quite controversial among some readers but I believe coworkers in the EMS field contribute to stress. There are some providers who are downright unpleasant to spend 10 minutes with, never mind an entire shift. When there are BLS crews afraid to call for ALS for fear of being berated by a paramedic, there is clearly an issue with professionalism. The attitude of “suck it up” or “you haven’t been around long enough to be stressed” needs to be left behind if this profession is to move forward. I will make no secret of the fact that I moved to a less busy, suburban assignment because I was starting to see warning signs in myself. I was becoming extremely irritable at work and at home and nearly lost a relationship because of it. At this point I had been in EMS only about 4 years but had experienced several stressful calls over a short time. I made the choice that was right for me and was still questioned by coworkers who believed I was “lazy.”

    EMS personnel in general handle stress poorly. This could be due to the nature of the business or not wanting to be perceived as “weak.” Nothing will change unless we all change our attitudes. Unfortunately, I don’t see this one changing any time soon.

  2. Scott, I am glad you regularly return to this topic. What are some specific ways that have worked for you to speak up to a colleague? I would love to read how you and others do this.

    One of the best moves of my EMS career was to see a counselor through my employers employee assistance program. I needed to talk to someone that was not co-worker, supervisor, or wife about a work related incident. The EAP is powerful resource available to us. Knowing that it is available and how to access it is really important for long-term success in EMS and at home.

  3. I’m glad to see your discussion on this topic Scott. Just today I was thinking about whose responsibility it is to say something when warning signs are present.

    I hate to bring up “this one time at a service that I know”, but I have had a recent case where an entire shift felt that they were doing the right thing by a co-worker who was under severe home and work stress by isolating and “protecting him. The attitude was that “We handle things IN-HOUSE”, fearing seeking assistance in any way would immediately jeopardize his career. While this was clearly the wrong path to take, especially in a service that has an Employee Assistance Program.

    Many readers may think “Of course you’d say something. Common sense! Who wouldn’t?”, but I mention the story above to support your point. Not everyone would. In fact, some may make the situation worse albeit with good intentions.

    We preach it to other so thank you Scott for remind us “If you see something, say something.” It doesn’t just apply to suspicious packages.

  4. Bob Sullivan /

    Great insight, Scott. Your post reminded me of two JEMS articles. One is by Skip Kirkwood about resiliency:

    The other is from Thom Dick about how we need to stop wasting people:

    As an industry, we don’t do a very good job taking care of each other. It is sad that the one common trait of each service type I’ve worked for is gossip about other people’s problems behind their back. This tears organizations apart and ruins careers. As we mature into a profession, I hope leaders recognize how destructive this is. Our people need to be well, both physically and mentally, in order to delver good patient care.

  5. Cindy Foster /

    Compassion Fatigue and PTSD are as real and as serious as heart disease or diabetes. Every 911 responder suffers to one degree or another. The two biggest factors in prevention and intervention are employers attitudes toward it and the co-worker attitude of “if you can’t handle the heat get out of the kitchen” stigma. Followed by the fear of being perceived as weak. “There’s no crying in EMS, Fire or Police services” is crap and the worst offenders are those of us in the services. We need to start in the classroom. The academy and the colleges. 0.02% of police training is spent on mental hygiene for police officers, less than that at the fire academy and Basic EMT programs lecture approx 45 minutes and another 45 minutes at the Paramedic level. Granted some programs do more, but some do less. There needs to be an industry standard across the board.
    Then there’s the employer. Some shine in this arena and others are simply non-existant. While MOST police departments do psych eval’s pre-employment others do not and the evals are not standardized. Again with fire, some do, some don’t. Private service….I have yet to hear of a company that does a pre-employment psych eval.
    Again, at the employment level, on going support has to be prevelent. All departments have a CAD system of one kind or another. The type of calls are recorded. On some kind of regular schedule a good look at how many crappy calls needs to be looked at, the volume of calls, amount of hours worked and the amount of sick time taken can be tracked. IS THERE AN ISSUE HERE can be figured out by and einstein.
    CISD is great, it has it’s place if it’s done right…and there enlies the problem…if it’s done right if at all.
    EAP programs are nothing more than a referral program. Some work, some don’t. Again, no industry standard.
    But ultimately who is responsible. I say we are, the street provider.
    We need to abolish the stigmas behind stress, depression, substance abuse and suicidal ideations amongst ourselves and in our communities. We need to demand our educational systems clearly train and aid us in implementing a plan which includes a therapist we can reach out to.
    Our employers need to provide us with strong, realistic support. Happy employees are productive employees. Mental health benfits bring down the medical costs of running a business, sick days, injuries and reprocussions from substance abuse.
    it’s a long process. But every single one of us is worth it.


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