Crushing Like a
Heart Attack:Evidence of the stress and mental health challenges faced by NYS EMS Responders
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Welcome to The Frontline Review, a newsletter from the Institute for Disaster Mental Health (IDMH) at SUNY New Paltz in partnership with the New York State Department of Health. Formerly known as The DMH Responder, The Frontline Review will be published bi-monthly to provide regular, up-to-date information on issues at the crossroads of frontline response work and mental health.
New York State First Responder Mental Health Needs Assessment
This inaugural issue of The Frontline Review presents results from the New York State First Responder Mental Health Needs Assessment (MHNA), commissioned by the NYS Division of Homeland Security and Emergency Services and conducted by the Benjamin Center and the Institute for Disaster Mental Health at SUNY New Paltz. The MHNA surveyed over 6,000 first responders across NYS, and conducted follow-up focus groups, about the stress and challenges that arise from their work, the mental health and personal impacts of those challenges, and the barriers to seeking and accessing care. Over 2,000 EMS professionals participated in the survey. Results about the stress and mental health impacts of first responder work for EMS are presented here.
MHNA: Stressors and challenges
The MHNA asked respondents to report sources of stress in their first responder work. Of the respondents that serve as EMS, 64% indicated that traumatic events, such as shootings and motor vehicle accidents, were a source of work-related stress. Just over half (52%) reported that situations encountered on the job, such as domestic violence calls or overdoses, were a source of stress. Both of these outcomes are higher in the EMS community than the broader first responder community (56% and 44% of all respondents cite traumatic events and situations encountered on the job as sources of stress, respectively).
Practical aspects of first responder work were also a source of stress. Paperwork and overtime were cited by approximately 3 in 10 EMS respondents, and approximately 4 in 10 stated that shiftwork and risk of injury while on the job were sources of stress. This last statistic is particularly meaningful, given that 64% of EMS also reported challenges from a lack of access to healthcare.
"I'm smiling on the outside but sobbing on the inside. I try my best to seem strong and unbothered. But if someone asked me if I was okay I would probably break."
-MHNA participant
EMS respondents also reported several social stressors that arise from their work. More than one-third of EMS respondents reported that they felt a lack of understanding about their work from family and friends (39%) and that their work limited their social life (36%). Just under half reported that not enough time spent with family and friends was a source of stress (46%). Eighty-three percent reported negative impacts on homelife, with another 75% reporting negative impact on family relationships and 71% reporting negative impacts on friendships. These findings are particularly poignant in light of research that demonstrates that quality social support systems can mitigate the impact of prolonged and traumatic stress (Hobfoll et al., 2007).
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As these results make clear, there is no shortage of stress for first responders. Stress emanates from the traumatic events and challenging situations encountered in their work, the daily grind of the job, and alienation from social support networks. And while stress is a universal experience and the human body is typically able to manage day-to-day stressors, the traumatic and chronic stress that first responders face appears to be elevated beyond that which most people generally experience, placing them at increased risk for mental health challenges (Geronazzo-Alman et al., 2017).
MHNA: Mental health impacts
Of EMS surveyed through the MHNA, 69% reported experiencing stress, 65% reported experiencing burnout, and 55% reported experiencing anxiety related to their first responder work. Sixty-one percent of EMS responders were plagued by uncontrollable worry as a result of their EMS work. Reports of anxiety, burnout, and stress are all slightly higher among EMS responders compared to all first responders.
In addition to stress, anxiety, and burnout, the MHNA also asked first responders to report on their experience of post-traumatic stress disorder (PTSD). Thirty-seven percent of EMS responders reported having experienced PTSD as a result of their work. This number is higher among EMS responders than the first responder field as a whole (29%). The MHNA also asked respondents to report on their experience of some mental health symptoms associated with PTSD. Interestingly, more EMS reported experiencing these symptoms than those that reported experiencing PTSD itself (37%); 83% reported sleep disturbances, 72% reported diminished interest in activities, 71% reported experiencing flashbacks, and 69% reported increased hypervigilance.
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MHNA also asked respondents to report on their experience of depression and suicidal thoughts. Of the EMS responders surveyed, 39% indicated that they had experienced depression as a result of their first responder work, which was slightly higher than the rate for all NYS first responders (33%). Similarly, reports of mental health symptoms that are associated with depression, such as diminished interest in daily activities (72%), sadness and hopelessness (64%), and thoughts about suicide (20%), were all higher for EMS responders than for the total population surveyed. In addition, EMS responders reported experiencing estrangement from family, friends and colleagues (56%) and aggressive or reckless behavior (40%).
"Mental health is by far the biggest problem in my life... It is crushing like a heart attack."
- MHNA participant
The statistic regarding thoughts of suicide is notable. As
described above, 20% of EMS responders surveyed reported experiencing thoughts about suicide related to their work. In comparison, 16% of all first responders reported having experienced thoughts about suicide. These statistics are higher than among the general population in NYS (4%). In other words, first responders are 4 times more likely, and EMS responders are 5 times more likely to experience thoughts about suicide than the general population in NYS. This is consistent with other literature on the topic, which has shown increased rates of suicidal ideation among EMS responders compared to the general population (Abbott, 2015).
MHNA: Conclusion
The NYS First Responder Mental Health Needs Assessment paints a vivid picture of the challenges facing New York’s first responders. Through the MHNA, first responders revealed their experience of the chronic and traumatic stressors that derive from their work, and the mental health impacts they confront as a result. These findings are pronounced for EMS who, in general, reported experiencing these stressors and mental health challenges more than the NY first responder population as a whole.
As one MHNA participant wrote, “Mental health is by far the biggest problem in my life… It is crushing like a heart attack.” The MHNA results show that responders across New York are struggling. In the next issue of The Frontline Review, we will explore MHNA findings about the barriers that keep first responders from seeking and receiving support for their mental health and psychosocial needs, as well as some of the potential solutions to address these identified mental health challenges.
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Contact Us
Institute for Disaster Mental Health
Science Hall 148
1 Hawk Drive, New Paltz, NY 12561-2440
Phone: (845) 257-3477
Email: idmh@newpaltz.edu
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Watch our Most Recent Webcast!
Click below to watch a recording of our 2024 webcast, Effective Response to Chemical Disasters: Leadership, Communication, and Lessons Learned from East Palestine.
Joining us to provide an overview on chemical disasters was Dr. David Heslop, Associate Professor at UNSW Sydney and the Chair of the World Association for Disaster Emergency Medicine (WADEM) special interest group on chemical, biological, radiological and nuclear (CBRN) disasters. We were also joined by Barbara Thomas and Emily Probst of the Northern Ohio Red Cross, who werer both instrumental in the Red Cross response to the East Palestine, OH train derailment and chemical spill.
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Other Mental Health Resources to Check Out!
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