The State of Emergency Medical Services Clinician Mental Health in Virginia
Article Sidebar
Main Article Content
Abstract
Background: In the United States, research has found that emergency medical service (EMS) clinicians contemplate and attempt suicide at a rate approximately 10 times higher than the general population. However, prior to this study, no comprehensive data existed on the mental health status and needs of Virginia’s EMS clinicians.
Objective: To evaluate mental health conditions, substance use, COVID-19 stress, and job satisfaction among Virginia’s EMS clinicians and to assess the perceived mental health cultures, services, and barriers to seeking help within clinicians’ agencies.
Methods: The [redacted institution name] constructed a comprehensive EMS clinician mental health cross-sectional survey during the spring of 2022. The survey was sent to every certified EMS clinician over the age of 18 with a working email address within the Commonwealth (N=36,376) as of April 15, 2022.
Results: A total of 2,930 EMS clinicians who actively served in EMS within the past 12 months responded to the survey. On average, clinicians reported 9.9 days of perceived poor mental health out of a 30-day period, with 9.1% of clinicians seriously contemplating suicide within the past year. Almost 60% of respondents reported heavy alcohol consumption at least once in the year prior to the survey, while 6.5% had taken prescription drugs for non-medical reasons and 3.7% had used illegal drugs. Approximately 66% of clinicians felt the coronavirus pandemic increased workplace stress. More than half of respondents (57.3%) indicated they had intentions to quit working in EMS. Finally, 31.1% of clinicians disagreed or strongly disagreed that EMS clinician mental health is important to their agency.
Conclusion: Virginia’s EMS clinicians experience a greater number of perceived poor mental health days, higher levels of suicide contemplation, and increased substance use as compared to the general population. Further health promotion actions are needed to address these disparities among Virginia’s EMS clinicians.
Article Details
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Publishing in IJOP allows authors to keep their copyright while giving IJOP unrestricted copyright permissions. Articles published in IJOP use Creative Common Attribution 4.0 International (CC BY-ND 4.0) licensing. This license requires that re-users give credit to the creator. It allows re-users to copy and distribute the material in any medium or format in unadapted form only, even for commercial purposes. Additional terms apply and can be accessed here.
Publishing in IJOP also allows authors to have contracts for non-exclusive distribution of the Journal's published version of the article, such as posting to an institutional repository or publication in a book, on the condition that the original publication in the original layout format in IJOP is retained and acknowledged.
We permit and encourage authors to post the articles they published in IJOP on their affiliated websites. This helps share the information, encourages citation in other works, and promotes scholarly discourse in the spirit of open access.
References
Abbott, C., Barber, E., Burke, B., Harvey, J., Newland, C., Rose, M., & Young, A. What’s Killing our Medics? Conifer, CO: Reviving Responders; 2015. Retrieved April 3, 2023, from https://static1.squarespace.com/static/555d1154e4b09b430c18fd39/t/5599d2b2e4b0c805c287aa3a/1436144306212/What%27s+Killing+Our+Medics+Final.pdf
Mental Health America (2022). Adult data 2022. Retrieved May 3, 2023, from: https://mhanational.org/issues/2022/mental-health-america-adult-data
Alcohol use in the United States: Age groups and demographic characteristics. (2023). Retrieved May 3, 2023, from https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-use-united-states-age-groups-and-demographic-characteristics
Alhazmi, R. A., Parker, R. D., & Wen, S. (2018). Needlestick injuries among emergency medical services providers in urban and rural areas. Journal of Community Health, 43(3), 518-523. https://doi.org/10.1007/s10900-017-0446-0.
American Psychological Association (APA). APA dictionary of psychology. APA website. Retrieved December 16, 2021, from https://dictionary.apa.org/verbal-abuse
Bacharach, S. B., Bamberger, P. A., & Doveh, E. (2008). Firefighters, critical incidents, and drinking to cope: The adequacy of unit-level performance resources as a source of vulnerability and protection. The Journal of Applied Psychology, 93(1), 155-169. https://doi.org/10.1037/0021-9010.93.1.155
Barger, L. K., Rajaratnam, S. M., Wang, W., O’Brien, C. S., Sullivan, J. P., Qadri, S., Lockley, S. W., & Czeisler, C. A. (2015). Common sleep disorders increase risk of motor vehicle crashes and adverse health outcomes in firefighters. Journal of Clinical Sleep Medicine, 11(3), 233-240. https://doi.org/10.5664/jcsm.4534.
Behnke, A., Rojas, R., Karrasch, S., Hitzler, M., & Kolassa, I. T. (2019). Deconstructing traumatic mission experiences: Identifying critical incidents and their relevance for the mental and physical health among emergency medical service personnel. Frontiers in Psychology, 10, 2305. https://doi.org/10.3389/fpsyg.2019.02305.
Bentley, M. A., Crawford, J. M., Wilkins, J. R., Fernandez, A. R., & Studnek, J. R. (2013). An assessment of depression, anxiety, and stress among nationally certified EMS professionals. Prehospital Emergency Care, 17(3), 330-8. https://doi.org/10.3109/10903127.2012.761307
Bentley, M. A. & Levine, R. (2016). A national assessment of the health and safety of emergency medical services professionals. Prehospital Disaster Medicine, 31(S1), S96-S104. https://doi.org/10.1017/S1049023X16001102.
Blanchard, J., Li, Y., Bentley, S. K., Lall, M. D., Messman, A. M., Liu, Y. T., Diercks, D. B., Merritt-Recchia, R., Sorge, R., Warchol, J. M., Greene, C., Griffith, J., Manfredi, R. A., & McCarthy, M. (2022). The perceived work environment and well‐being: A survey of emergency health care workers during the COVID‐19 pandemic. Academic Emergency Medicine, 29(7), 851-861. https://doi.org/10.1111/acem.14519
Bureau of Justice Statistics (BJS). Violent crime. BJS website. Retrieved December 16, 2021, from https://bjs.ojp.gov/topics/violent-crime
Centers for Disease Control and Prevention (CDC). (2018). 2018 BRFSS questionnaire. CDC. Retrieved March 22, 2023, from https://www.cdc.gov/brfss/questionnaires/pdf-ques/2018_BRFSS_English_Questionnaire.pdf
Centers for Disease Control and Prevention (CDC). (2021). 2020 BRFSS questionnaire. CDC. Retrieved March 22, 2023, from https://www.cdc.gov/brfss/questionnaires/pdf-ques/2020-BRFSS-Questionnaire-508.pdf
Centers for Disease Control and Prevention (CDC). (n.d.). CDC HRQOL–14 "Healthy Days Measure." CDC. Retrieved April 3, 2023, from https://www.cdc.gov/hrqol/hrqol14_measure.htm
Centers for Disease Control and Prevention (CDC). (2022). Mental health conditions: Depression and anxiety. CDC website. Retrieved April 3, 2023, from https://www.cdc.gov/tobacco/campaign/tips/diseases/depression-anxiety.html
Centers for Disease Control and Prevention (CDC). (2013). Traumatic incident stress. CDC. Retrieved April 3, 2023, from https://www.cdc.gov/niosh/topics/traumaticincident
Cydulka, R. K., Emerman, C. L., Shade, B., & Kubincanek, J. (1997). Stress levels in EMS personnel: a national survey. Prehospital Disaster Medicine, 12(2), 136-140. Retrieved from https://www.cambridge.org/core/journals/prehospital-and-disaster-medicine/article/abs/stress-levels-in-ems-personnel-a-national-survey/B4E4F2E005278C46ACDA5F1E48381B44
Donnelly, E. A., Bradford, P., Davis, M., Hedges, C., Socha, D., & Morassutti, P. (2019). Fatigue and safety in paramedicine. Canadian Journal of Emergency Medicine, 21(6), 762-765. https://doi.org/10.1017/cem.2019.380
Donnelly, E. (2012). Work-related stress and posttraumatic stress in emergency medical services. Prehospital Emerg Care, 16(1), 76-85. https://doi.org/10.3109/10903127.2011.621044
Fairfax Coalition of Police Local 5000. (n.d.) 2019 Virginia public safety mental health pilot survey. Retrieved April 3, 2023, from https://pdf4pro.com/view/2019-virginia-public-safety-mental-health-pilot-survey-5b8e89.html
Glossary. (2023). Retrieved May 3, 2023, from https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/glossary
Goodwin, J. & Lane, P. (2016). 2016 national survey on EMS mental health services. NAEMT. Retrieved April 3, 2023, from https://www.interagencyboard.org/system/files/resources/2016-naemt-mental-health-report-8-14-16.pdf
Gormley, M. A., Crowe, R. P., Bentley, M. A., & Levine, R. (2016). A national description of violence toward emergency medical services personnel. Prehospital Emergency Care, 20(4), 439-447. https://doi.org/10.3109/10903127.2015.1128029
Grandner, M. A., Jackson, N. J., Izci-Balserak, B., Gallagher, R. A., Murray-Bachmann, R., Williams, N. J., Patel, N. P., & Girardin, J. (2015). Social and behavioral determinants of perceived insufficient sleep. Frontiers in Neurology, 6, 112. https://doi.org/10.3389/fneur.2015.00112.
Gulliver, S. B., Zimering, R. T., Dobani, F., Pennington, M. L., Morissette, S. B., Kamholz, B. W., Knight, J. A., Keane, T. M., Kimbrel, N. A., Carpenter, T. P., & Meyer, E. C. (2019). Alcohol use and mental health symptoms in female firefighter recruits. Occupational Medicine, 69(8-9), 625-631. https://doi.org/10.1093/occmed/kqaa015
Gulliver, S. B., Zimering, R., Knight, J., Morissette, S., Kamholz, B., Meyer, E., Keane, T., Pennington, M., Denman, T., Carpenter, T., & Kimbrel, N. (2018). Tobacco and alcohol use among firefighters during their first 3 years of service. Psychology of Addictive Behaviors, 32(3), 255-263. https://doi.org/10.1037/adb0000366
Haugen, P. T., McCrillis, A. M., Smid, G. E., & Nijdam, M. J. (2017). Mental health stigma and barriers to mental health care for first responders: a systematic review and meta-analysis. Journal of Psychiatric Research, 94, 218-229. https://doi.org/10.1016/j.jpsychires.2017.08.001
Heyman, M., Dill, J., & Douglas, R. (2018). The Ruderman white paper on mental health and suicide of first responders. Ruderman Family Foundation. Retrieved April 3, 2023 from https://rudermanfoundation.org/white_papers/police-officers-and-firefighters-are-more-likely-to-die-by-suicide-than-in-line-of-duty/
Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J., Katz, E. S., Kheirandish-Gozal, L., Neubauer, D. N., O’Donnell, A. E., Ohayon, M., Peever, J., Rawding, R., Sachdeva, R. C., Setters, B., Vitiello M. V., Ware, J. C., & Adams Hillard, P. J. (2015). National Sleep Foundation's sleep time duration recommendations: methodology and results summary. Sleep Health, 1(1), 40-43. https://doi.org/10.1016/j.sleh.2014.12.010.
Karnick, A. T., Buerke, M., Caulfied, N., Trussell, D., Capron, D. W., & Vujanovic, A. (2022). Alcohol use in firefighters: A network model of behaviors and transdiagnostic risk. Drug and Alcohol Dependence, 241, 1-7. https://doi.org/10.1016/j.drugalcdep.2022.109677
Kecklund, G. & Axelsson, J. (2016). Health consequences of shift work and insufficient sleep. British Medical Journal, 355, i5210. https://doi.org/10.1136/bmj.i5210
Kirzinger, A., Kearney, A., Hamel, L. & Brody, M. (2020). KFF health tracking poll – early April 2020: The impact of coronavirus on life in America. Retrieved April 30, 2023, from https://www.kff.org/coronavirus-covid-19/report/kff-health-tracking-poll-early-april-2020/
Krystal, A. D. (2012). Psychiatric disorders and sleep. Neurologic Clinics, 30(4), 1389-1413. https://doi.org/10.1016/j.ncl.2012.08.018
Lin, M. H., Huang, Y. C., Chen, W. K., & Wang, J. Y. (2020). Sleepiness and injury risk in emergency medical service workers in Taiwan. PLoS One, 15(2), e0229202. https://doi.org/10.1371/journal.pone.0229202
Maguire, B. J. & O'Neill, B. J. (2017). Emergency medical service personnel's risk from violence while serving the community. American Journal of Public Health, 107(11), 1770-1775. https://doi.org/10.2105/AJPH.2017.303989
Maguire, B. J., O'Meara, P., O'Neill, B. J, & Brightwell, R. (2018). Violence against emergency medical services personnel: a systematic review of the literature. American Journal of Industrial Medicine, 61(2), 167-180. https://doi.org/10.1002/ajim.22797
Marczewski, K. P., Piegza, M., Gospodarczyk, A., Pudlo, R., & Sosada, K. (2021). Emotional problems and sleep disturbances in paramedics in the era of the COVID-19 pandemic. Wiadomości Lekarskie (1960), 74(7), 1754-1757. https://doi.org/10.36740/WLek202107133
Martin, C. E., Vujanovic, A. A., Paulus, D. J., Bartlett, B., Gallagher, M. W., & Tran, J. K. (2017). Alcohol use and suicidality in firefighters: Associations with depressive symptoms and posttraumatic stress. Comprehensive Psychiatry, 74, 44-52. https://doi.org/10.1016/j.comppsych.2017.01.002
Martin, C. E., Tran, J. K., & Buser, S. J. (2017). Correlates of suicidality in firefighter/EMS personnel. Journal of Affective Disorders, 208, 177-183. https://doi.org/10.1016/j.jad.2016.08.078
Medic, G., Wille, M., & Hemels, M. E. (2017). Short- and long-term health consequences of sleep disruption. Nature and Science of Sleep, 9, 151-161. https://doi.org/10.2147/NSS.S134864
Meyer, E. C., Zimering, R., Daly, E., Knight, J., Kamholz, B. W., & Gulliver, S. B. (2012). Predictors of posttraumatic stress disorder and other psychological symptoms in trauma-exposed firefighters. Psychological Services, 9(1), 1-15. https://doi.org/10.1037/a0026414
National Institute on Drug Abuse (NIDA). (n.d.). NIDA Drug Use Screening Tool NIDA-modified ASSIST. Retrieved December 16, 2021, from https://archives.drugabuse.gov/nmassist/
Patterson, P. D., Weaver, M. D., Frank, R. C., Warner, C. W., Martin-Gill, C., Guyette, F. X., Fairbanks, R. J., Hubble, M. W., Songer, T. J., Callaway, C. W., Kelsey, S. F., & Hostler, D. (2012). Association between poor sleep, fatigue, and safety outcomes in emergency medical services providers. Prehospital Emergency Care, 16(1), 86-97. https://doi.org/10.3109/10903127.2011.616261
Paulus, D. J., Vujanovic, A. A., Schuhmann, B. B., Smith, L. J., & Tran, J. (2017). Main and interactive effects of depression and posttraumatic stress in relation to alcohol dependence among urban male firefighters. Psychiatry Research, 251, 69-75. https://doi.org/10.1016/j.psychres.2017.02.011
Piazza-Gardner, A., Barry, A. E., Chaney, E., Dodd, V., Weiler, R., & Delisle, A. (2014). Covariates of alcohol consumption among career firefighters. Occupational Medicine, 64(8), 580-582. https://doi.org/10.1093/occmed/kqu124
Pourshaikhian, M., Abolghasem, Gorji H., Aryankhesal, A., Khorasani-Zavareh, D., & Barati, A. (2016). A systematic literature review: workplace violence against emergency medical services personnel. Archives of Trauma Research, 5(1), e28734. https://doi.org/10.5812/atr.28734
Virginia Office of Emergency Medical Services (2017). Virginia Office of Emergency Medical Services state strategic and operational plan, 2017-2019. Retrieved April 3, 2023, from http://www.vdh.virginia.gov/content/uploads/sites/23/2016/06/StateEMSPlan.pdf
Virginia Office of Emergency Medical Services (2018). Make the Call – Mental Health and Wellness. Virginia Department of Health. Retrieved April 3, 2023, from http://www.vdh.virginia.gov/emergency-medical-services/emergency-operations/cism/
REDCap. About. REDCap website. Retrieved March 23, 2023, from https://projectredcap.org/about/
Reichard, A. A., Marsh, S. M., Tonozzi, T. R., Konda, S., & Gormley, M. A. (2017). Occupational injuries and exposures among emergency medical services workers. Prehospital Emergency Care, 21(4), 420-431. https://doi.org/10.1080/10903127.2016.1274350
Reichard, A.A., Al-Tarawneh, I.S., Konda, S., Wei, C., Wurzelbacher, S. J., Meyers, A. R., Bertke, S. J., Bushnell, T., Tseng, C., Lampl, M. P., & Robins, D. C. (2018). Workers' compensation injury claims among workers in the private ambulance services industry-Ohio, 2001-2011. American Journal of Industrial Medicine, 61(12, 986-996. https://doi.org/10.1002/ajim.22917.
Reti, T., de Terte, I., & Stephens, C. (2022). Traumatic exposure, work-related stressors and gender as risk factors in the development of psychological distress for ambulance personnel. Traumatology (Tallahassee, Fla.), 28(1), 46-55. https://doi.org/10.1037/trm0000315
Robert Wood Johnson Foundation: County health rankings & roadmaps. 2022 Virginia data. Retrieved March 30, 2023, from https://www.countyhealthrankings.org/explore-health-rankings/virginia?year=2022
Spector, P. (n.d.). Job satisfaction survey. Paul Spector website. Retrieved December 16, 2023, from https://paulspector.com/assessments/pauls-no-cost-assessments/job-satisfaction-survey-jss/
Sterud, T., Hem, E., Lau, B., & Ekeberg, O. (2008). Suicidal ideation and suicide attempts in a nationwide sample of operational Norwegian ambulance personnel. Journal of Occupational Health, 50(5), 406-414. https://doi.org/10.1539/joh.l8025.
Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Behavioral Health Statistics and Quality (CBHSQ). (2018). 2019 national survey on drug use and health (NSDUH). U.S. Department of Health & Human Services. Retrieved April 3, 2023, from https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHmrbCAISpecs2019.pdf
Taylor, J. A., Davis, A. L., Barnes, B., Lacovara, A. V., & Patel, R. (2015). Injury risks of EMS responders: Evidence from the National Fire Fighter Near-Miss Reporting System. British Medical Journal Open, 5(6), e007562. https://doi.org/10.1136/bmjopen-2014-007562
Thomas, B., O'Meara, P., & Spelten, E. (2017). Everyday dangers – The impact infectious disease has on the health of paramedics: A scoping review. Prehospital Disaster Medicine, 32(2), 217-223. https://doi.org/10.1017/S1049023X16001497
Substance Abuse and Mental Health Services Administration (SAMHSA) (2021). TOC. Retrieved May 3, 2023, from https://www.samhsa.gov/data/sites/default/files/reports/rpt39441/NSDUHDetailedTabs2021/NSDUHDetailedTabs2021/NSDUHDetTabsSect1pe2021.htm
U.S. Department of Veteran Affairs (VA). (n.d.). PTSD. VA website. Retrieved May 3, 2023, from https://www.mentalhealth.va.gov/mentalhealth/PTSD/index.asp
Vujanovic, A. A., Lebeaut, A., & Leonard, S. (2021). Exploring the impact of the COVID-19 pandemic on the mental health of first responders. Cognitive Behavioural Therapy, 50(4), 320-335. https://doi.org/10.1080/16506073.2021.1874506
Watanabe, B. L., Patterson, G. S., Kempema, J. M., Magallanes, O., & Brown, L. H. (2019). Is use of warning lights and sirens associated with increased risk of ambulance crashes? A contemporary analysis using National EMS Information System (NEMSIS) data. Annals of Emergency Medicine, 74(1), 101-109. https://doi.org/10.1016/j.annemergmed.2018.09.032
Weaver, M. D., Patterson, P. D., Fabio, A., Moore, C. G., Freiberg, M. S., & Songer, T. J. (2015). An observational study of shift length, crew familiarity, and occupational injury and illness in emergency medical services workers. Occupational and Environmental Medicine, 72(11), 798-804. https://doi.org/10.1136/oemed-2015-102966
Wild, J., McKinnon, A., Wilkins, A., & Browne, H. (2022). Post‐traumatic stress disorder and major depression among frontline healthcare staff working during the COVID‐19 pandemic. British Journal of Clinical Psychology, 61(3), 859-866. https://doi.org/10.1111/bjc.12340
Wolkow, A. P., Barger, L. K., O'Brien, C. S., Sullivan, J. P., Qadri, S., Lockley, S. W., Czeisler, C. A., & Rajaratnam, S. M. W. (2019). Associations between sleep disturbances, mental health outcomes and burnout in firefighters, and the mediating role of sleep during overnight work: A cross-sectional study. Journal of Sleep Research, 28(6), e12869. https://doi.org/10.1111/jsr.12869.
World Health Organization (WHO). (n.d.). QD85 burn-out. WHO website. Retrieved April 3, 2023, from https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/129180281
Wright, H. M., Griffin, B. J., Shoji, K., Love, T. M., Langenecker, S. A., Benight, C. C., & Smith, A. J. (2021). Pandemic-related mental health risk among front line personnel. Journal of Psychiatric Research, 137, 673-680. https://doi.org/10.1016/j.jpsychires.2020.10.045
Yu, B., Barnett, D., Menon, V., Rabiee, L., De Castro, Y. S., Kasubhai, M., & Watkins, E. (2022). Healthcare worker trauma and related mental health outcomes during the COVID-19 outbreak in New York City. PloS One, 17(4), e0267315. https://doi.org/10.1371/journal.pone.0267315