Building a Resilient EMS Workforce

To handle the stress associated with working in EMS, paramedics and EMTs benefit from good physical, mental and emotional health.

The greatest asset of any EMS agency is its people—the EMS practitioners and other personnel who are there for members of the community during their worst moments, and who ensure their patients receive high-quality, compassionate and lifesaving care. 

However, “being there” for patients and their family members and friends during medical emergencies is inherently stressful. EMS practitioners often work in harsh environments; under difficult, unpredictable circumstances; with limited information, assistance and resources. They may be exposed to risks such as infectious disease, physical violence, occupational injury, vehicle crashes and death. They may be called on to help victims of traumatic events, which can leave scars on the responders who bear witness.

To effectively handle the stress associated with working in EMS, EMTs and paramedics benefit from having good physical, mental and emotional health. Research shows that mental and emotional well-being lowers the risk of developing chronic physical conditions, while keeping healthy physically can help ward off conditions such as depression, anxiety and stress-related disorders. Resilience is also protective—responders who are resilient can bounce back more easily from adverse events and more readily adapt to change. 

Yet research also shows that some members of the EMS workforce face ongoing challenges in maintaining their mental, emotional and physical health—and that many EMS practitioners believe there is more that EMS agencies can do to help.

A 2015 survey of EMTs and paramedics published in the Journal of Emergency Medical Services (JEMS) found a high rate of suicidal thoughts among EMS practitioners. The survey found that 37 percent reported having contemplated suicide, nearly 10 times the rate of American adults.

In 2016, NAEMT’s National Survey on EMS Mental Health Services found that 37 percent of EMS agencies provided no mental health support for EMS practitioners, and 42 percent provided no health and wellness services. Even among those whose agencies provided counseling or resources such as employee assistance programs (EAPs), many EMS practitioners were reluctant to share their struggles for fear of being seen as weak.

A 2017 survey by the University of Phoenix of 2,000 U.S. adults employed as first responders, including firefighters, police officers, EMTs, paramedics and nurses, found 84 percent of first responders had experienced a traumatic event on the job and 34 percent had received a formal diagnosis of a mental health disorder such as depression or PTSD. For those diagnosed with depression, nearly half cited incidents at work as a contributing cause.

Getting Started: Building a Culture of Wellness and Resiliency

A culture of wellness and resiliency begins with an awareness of healthy lifestyles in the workplace. EMS agencies can help their personnel achieve this by providing educational opportunities, programs and hands-on experiences to address a large array of health and wellness-related topics for employees.

Attributes of a workplace that supports wellness and resilience include:

1. Offers opportunities for connection among employees. Social skills are associated with resilience, and the workplace is often a source of social support. Co-workers may also serve as an extended family. This may be particularly true in EMS, where teamwork is essential and EMS practitioners often form strong bonds. The opportunity to build friendships at work can contribute to a sense of belonging and a shared mission, and may offer support in helping to face challenges.

What can employers do? Employers can offer opportunities for employees to socialize with one another, in a variety of settings, to strengthen friendships and camaraderie.

2. Supports good physical health. Physical health is associated with good mental health and resiliency. Getting sufficient sleep, nutrition and exercise can ward off chronic illness, boost mood and provide protection from depression. People who are healthy physically are better able to face the emotional and psychological challenges of working in EMS.

What can employers do to help? Employers should establish policies and initiatives that promote a healthy lifestyle. Smoking cessation, weight loss programs, opportunities to exercise and fatigue mitigation are a few examples.

3. Fosters positivity. Positivity and optimism have been shown to bolster resilience. The work environment should be one in which employees receive recognition and appreciation for their work.   

What can employers do to help? Employers should cultivate good morale. Employers can show employees that they are valued by providing positive feedback and recognition for a job well done. Initiatives should also provide opportunities for peer-to-peer recognition—the chance to offer recognition and praise benefits both the giver and the recipient.  

4. Helps employees adapt to change. Change can be very stressful, whether it’s a new company owner or a new way of performing a procedure. As an employer, transparency and a commitment to keeping your employees informed will create an environment in which individuals are better able to accept change.

What can employers do to help? Provide support for employees in adapting to change by getting feedback prior to implementing a change, leading by example, clearly communicating the benefits of the change, and by providing adequate training on implementing the change. 

5. Empowers employees to identify solutions. Research suggests that individuals with strong problem-solving skills tend to be more resilient. Having a sense of control over one’s circumstance also boosts resiliency.  

What can employers do? Help employees develop their problem-solving skills. Challenge your employees to make meaningful contributions, set goals and support those goals. Ask for their input and ideas for solving issues or improving conditions in the workplace, and make sure employees know how their feedback is incorporated into new policies or procedures. 

Defining Wellness and Resilience

What is Wellness? 
Wellness is an active process of becoming aware of and learning to make healthy choices, according to the National Wellness Institute. Wellness means more than simply not being ill; it focuses on keeping your body in good condition to prevent certain chronic diseases. True wellness is proactive and recognizes that each individual has mental, physical and social needs that must be fulfilled to maintain optimal health. 

What is Resilience?
Resilience is the ability to cope with stress and adversity without suffering lasting physical or psychological harm. Resilient people bounce back from setbacks. Resilience also provides protection from PTSD. When faced with a traumatic or stressful situation, resilient people are able to move past what occurred and resume their lives. 

Factors associated with resilience include: optimism, the ability to stay balanced and manage strong or difficult emotions, a sense of safety and a strong social support system. Some people are naturally more resilient than others. But research shows that resilience isn’t a fixed trait. Resilience is a set of skills that can be taught and learned—and EMS agencies play a role in this. 


Helping EMS Agencies Help the EMS Workforce
To assist EMS agencies in developing programs that help EMS personnel maintain their physical, mental and emotional wellbeing, NAEMT has developed a Guide to Building an Effective EMS Wellness and Resiliency Program. The guide presents:

  • Steps agencies can take to develop a culture of resilience and wellness.
  • Strategies for building resilience among EMS professionals.
  • Suggestions for specific programs and initiatives to support a healthy EMS workforce.
  • Tips for EMS agencies on what resilience and wellness initiatives worked for them.
  • Ideas for engaging community partners and stakeholders with supporting the wellness and resiliency of EMS practitioners. 

To get your copy of the NAEMT Guide, visit