The daily trauma of responding to traffic accidents, domestic violence, and sudden illness is taking a serious toll on Canadian paramedics’ mental health. But these professionals can’t always get the support that they need.

A Government of Canada survey on mental health and stressful events reported that 6.1% of Canadian adults have a diagnosis of posttraumatic stress disorder (PTSD) from a health professional. According to studies and experts in the field, the national incidence of mental health disorders, including depression, anxiety, PTSD, and suicidal ideation, among paramedics is roughly 20%. 

The literature indicates that the occupation is associated with a risk for long-lasting mental health effects and a high probability of these effects, David Wolff, provincial chair of the Ontario Paramedic Association’s Wellness Committee and a semi-retired paramedic, told Medscape Medical News. But there is no consensus on their causes or on precisely what paramedics are experiencing.

“Twenty percent of first responders exceed the hazardous alcohol [consumption] threshold. Some studies report that 23% of public safety personnel screened positive for PTSD, and 26% for major depressive disorder,” said Wolff. 

A Multifactorial Problem

Contrary to popular belief, mental health distress in paramedics isn’t necessarily caused by traumatic incidents, Wolff noted. Violence against paramedics, longer work shifts, personnel shortages, harassment, and leadership issues often lead to burnout. Inadequate patient care is a concern, particularly in Ontario where the paramedic sector is unregulated and procedural protocols don’t always adequately meet the needs of people in emergency situations.

“A large part of the pressures that paramedics face [comprises] controllable stressors, including toxic workplaces and psychosocial issues, in conjunction with the calls they go on. It’s a synergistic effect,” Daniel Sundahl, a registered counselling therapist with the Canadian Professional Counsellors Association and an advanced care paramedic with the Alberta College of Paramedics, told Medscape Medical News. “Much of the culture that paramedics work in is negative-based reinforcement for behavior change, rather than positive reinforcement. It’s not a supportive culture for paramedics to best manage the stresses of the job.” Harassment such as hazing has been normalized, added Sundahl. 

Michel Di Iorio, a retired Quebec paramedic, agreed, stating that the current protocol prioritizes basic pretransportation stabilization of the patient and rapid transfer to a hospital. But many hospitals are understaffed to handle the volume of patients arriving by ambulance. 

“First responders are subjected to the devastating effects of trauma on their self-esteem, because of the inherent inability to ‘save them all,’ ” added Di Iorio. They’re often unable to vent their frustrations, fears, guilt, and anger, unable to share these with friends or family members. This can lead to destructive coping mechanisms like substance abuse and domestic violence. The average paramedic works less than 10 years before they experience a professional burnout or depression, he said.

Preventive Measures Needed 

While the 20% of paramedics with mental health issues receive the most attention, attention should be paid to the 80% who do not have these issues, said Wolff, and to the factors contributing to their psychological wellness. “The bulk of funds being injected into support programs is for responsive measures, rather than proactive, preventive measures. Preparing new paramedics properly to ensure their psychological well-being should take precedence over trying to fix the problem once it has occurred,” Wolff concluded. 

“The onus is on paramedics to ask for help, and that really doesn’t work. There needs to be a paradigm shift where support is integrated into the culture of the workplace, where mental health support is normalized and considered on par with physical injuries,” added Sundahl. 

Government programs and organizations like Road to Recovery (which provides alcohol and addiction treatment) and Wounded Warriors (which serves organizations and individuals who have been exposed to trauma) provide education and resiliency counselling. 

Peer Connect, an Ontario-based proactive wellness and peer support program for first responders, was launched in 2019 in response to growing demand from Emergency Medical Services (EMS) in Ontario. Roughly 75% of Ontario EMS groups use the platform. 

Peer Connect acts as a mental health resource hub and provides a suite of services tailored to EMS needs. The services incorporate employee assistance programs, evidence-based feedback, and check-ins after critical incident calls like child drownings. 

“A lot of the need is related to the opioid crisis, burnout, employee retention, the growing number of emergency calls, and an insufficient number of ambulances,” said Nik Fiorito, chief strategy officer of Peer Connect. “As a result, a lot of paramedics feel resentment toward management for not providing enough support, creating a poor frontline culture.” 

Di Iorio noted a lack of mental health support for paramedics, leaving them dangerously vulnerable to mental trauma and its negative consequences. “I advocate for the necessary resources to provide optimal care and programs to help frontline responders better cope with their feelings of guilt, helplessness, and inadequacy that inevitably accompany failed attempts to assist the victims,” he said. “I also advocate for the necessary training to allow them to better accomplish the tasks set before them, as well as a level of trust that would remove the handcuffs from their wrists, allowing them to respond to the very best of their abilities.” 

Wolff, Sundahl, Di Iorio, and Fiorito reported no relevant financial relationships. 

Evra Taylor is a widely published freelance medical writer and reporter with 20 years’ experience covering a broad range of therapeutic sectors, including family health, cardiology, psychiatry, ophthalmology, and dermatology.