How ignoring mental health issues in EMS can impact the organization

Editor’s Note: Suicide is always preventable. If you are having suicidal thoughts or feeling suicidal, call the National Suicide Prevention Hotline immediately on 988. Counselors are also available to chat on www.suicidepreventionlifeline.org. Remember: you deserve to be supported, and it’s never too late to get help. Talk to someone today.


By Jay Fitch, PhD

There is a culture of silence surrounding mental health in the EMS/public safety profession. The stigma surrounding mental health care for EMTs, medics, firefighters, supervisors, and others is a major barrier to disclosure. Healthcare providers fear losing their professional identity and livelihood and being discriminated against if they come forward. The pandemic has exacerbated the mental health challenges faced by public safety team members. Staff shortages, mandatory overtime and fewer opportunities for training have all contributed to increased stress and anxiety.

Most likely, you know at least one caregiver who is struggling, but you are hesitant to take action. You may not know how to approach the topic, what to say without offending your colleague or emphasizing the difficulty, or whether you can make a difference. Hesitating out of fear or uncertainty can drastically impact an individual and the entire team and contribute to the growing EMS mental health crisis.

According to recent studies, an alarming number of healthcare providers have considered leaving the profession due to compassion fatigue. As members of a collaborative, compassionate field, EMS and public safety professionals must first learn to recognize problems and care for themselves and their colleagues so they can care for patients.

How one healthcare provider’s struggle can impact the entire system

Well-being issues, such as compassion fatigue, burnout and depression, are never neatly confined to a single team member. Instead, they influence every caregiver, changing the emotional, mental and practical climate of the service, shaping and influencing every process with a negative ripple effect. Common examples are:

  • Reduced morale. Negative thinking, irritability and emotional outbursts can hurt other team members, create tension and affect performance. Such behavior can also be contagious, creating a negative organizational culture and a vicious cycle of apathy and low morale.
  • Increased turnover. Quitting may be the healthiest choice for some people, but it can inspire others to leave, especially if the departing employee is well-liked or the anchor of the team.
  • Increased workload for others. When troubled team members are apathetic about their work and reduce or shout out their performance, their colleagues are forced to take on the additional burden or work more, which can create hostility in the workplace.
  • Decreased performance can jeopardize patient or team safety. Team members who feel hopeless, fatigued, or emotionally detached from their work can inadvertently compromise results and service quality.

Compassion fatigue versus burnout versus depression

The most common EMS mental well-being challenges fall into three distinct, often misunderstood conditions. Attributing a caregiver’s struggle to the wrong condition is more than a matter of semantics; leadership may fail to address the affected team member’s problem and therefore be unable to find an appropriate solution.

  • Compassion fatigue. Compassion fatigue stems from the deeply empathetic relationships EMS professionals have with their patients. When a person’s empathy is depleted by ongoing loss, trauma, and ethical dilemmas, they become emotionally disconnected from their work.
  • Burnout. Burnout results from workplace pressures and stressors, such as conflict, scheduling or compensation issues, interview pressure, or a lack of professional culture. In short, burnout is directly related to the work environment and not to the work itself.
  • Depression. Unlike compassion fatigue and burnout, which result from external circumstances, depression is classified as a real mental health problem. Depression can coincide with or be secondary to burnout or compassion fatigue and can be severe and lead to suicidal thoughts. Therefore, professional help is recommended.

Supporting the well-being of your team is a win-win situation

Fortunately, recognizing and helping a struggling provider – or having systems in place to do so – can create a system-wide culture change that benefits the entire team. Building and fostering a supportive work environment that welcomes constructive feedback, prioritises wellbeing and emphasizes open and honest communication – between leadership and each shift and between colleagues – means that caregivers with problems can not only seek help, but also the can reap the benefits of improved performance and employee retention systems.

Mature man comforts his friend

Identify and assist team members dealing with depression, burnout, or compassion fatigue to create an emotionally safe organizational environment


About the author
Jay Fitch, PhD, is a founding partner of the emergency services consulting firm, Fitch & Associates. He has nearly five decades of EMS/public safety experience and is now executive director of the nonprofit Fitch EMS Education Foundation.