EMS Wellness: Program Uptake and Roadblocks [2024 EMS Trend Survey]

Editor's Note: In August 2024, EMS1 and Fitch & Associates released their annual EMS trend survey, What Paramedics Want, proudly sponsored by Pulsara. Because the articles and advice found within contain such critical subject matter, we've elected to publish each segment one at a time here on our blog. Read, enjoy, share, and take to heart the following information brought to you by the most prestigious thought leaders in EMS. Today's entry is written by Joe Coons, director of safety and Communications Center manager at LifeFlight Eagle, a not-for-profit air medical service serving Northwest Missouri.

_____

Balancing organizational support and personal responsibility, Joe Coons examines how providers can engage in improving their health and wellness

Over the last 10 or so years, there has been a proliferation of wellness programs designed to help EMS providers maintain their mental and physical well-being. Agencies have stood up peer support teams, tailored employee assistance programs to meet the unique needs of our industry, purchased gym equipment and provided memberships. The question becomes: are we using them?

Physical well-being

Let’s start with physical health. According to a study published in 2021, 56% of EMS workers surveyed were considered obese using body mass index standards. Of those same workers, 48% did not meet the physical activity guidelines recommended by the CDC.

In the 2021 study, participants identified lack of energy, willpower and time as primary reasons for a lack of physical activity, ranking lack of resources last. Similarly, in the 2024 EMS Trend Survey, respondents ranked time and motivation as their biggest barriers to maintaining their physical health – indicating while the resources may be available, providers are still finding it difficult to adopt wellness strategies.

Physical health is important for cardiovascular health, keeping up with the demands of the job and avoiding injury. Strains and sprains make up the majority of injuries in EMS and are most commonly located in the back and neck area. Many EMS workers think that the job is cerebral, and it is. What they don’t account for is that moving humans for a living is physically demanding. Having some physical strength and cardiovascular fitness is very helpful towards accomplishing those moves without injury. We must take personal initiative to account for that and be ready, using the tools provided. Not only will this help avoid injury, but it can also lengthen a very rewarding career. If you’re an EMS professional who is struggling with getting started, or maintaining a physical fitness or activity routine, here are a few things that you can do to improve your health.

• Start small. Routines typically fail because we try to do it all at once – implementing a time-consuming, high-effort plan that changes everything. The problem is that life does happen and we will encounter challenges. That’s when we can falter, when it gets difficult, because changing everything is so overwhelming. By starting small, we’re giving ourselves some grace and taking it one step at a time. For physical activity, try taking the stairs versus an escalator. Set a small amount of time usually used for watching TV aside and going for a 30-minute walk instead. If you’re changing your eating habits, change by including something healthy instead of subtracting – something along the lines of adding more protein or greens first. Once you have that first small habit down, move on to another small step.
• Use the social dynamic in a positive way. One way to stay on top of change is accountability. By including yourself with a group of like-minded people with similar goals, it can be very helpful when it comes to overcoming feeling too tired or just not feeling it today. The cliché is that if you hang around five fit people, you will become the sixth.
• Track success. Most of the time, people look at the failure aspect of a new routine. “I didn’t make it to the gym today” or “I blew my diet for the day by eating cookies in the EMS room at the hospital.” These are things that can make a change feel negative. Instead, focus on the positives and document them. “I felt good walking the stairs today,” or “I was able to get all of my protein in” can set a positive mindset about change. Eventually, what we view as shortcomings will become insignificant and therefore less bothersome.

Mental well-being

In regard to our mental wellbeing, we’ve made leaps and bounds since I started in EMS in 1992. Back then, the thought process was to take whatever is bothering you and bury it deep down inside, never to be spoken of again. Thankfully, our industry’s culture has shifted greatly and for the most part, we’ve started to take a deep look at how the things we see and do affect us mentally.

As mentioned, many agencies have started peer support teams and adopted EAP programs equipped to deal with the unique concerns of the first responder community. If you’re lucky, the clinicians involved might even talk like us.

But, as with the physical aspect of our wellbeing, are we really taking advantage of the opportunities before us?

Only 4% of respondents to the 2024 EMS Trend Survey reported they don’t have any behavioral health programs or offerings available to them, but adoption rates are low – just 15% report accessing peer support and 12% accessing an EAP.

Even though the culture in our industry has shifted, there is still a lot of work to be done in terms of how we view seeking mental health. The reasons we don’t pursue the help available to us can be a pretty complex subject. There are some areas where asking for help with our mental health still carries a stigma of weakness.

EMS providers are also very self-reliant people, and we expect to be the rescuers, not the ones needing rescue. Many times, EMS workers can’t even recognize the fact that they’re in need of those services. Historically we haven’t been educated on the telling signs that our career path is affecting our mental health. We may get some of that education now, but maybe there’s not enough of an ongoing focus to ensure that it stays at the forefront.

Then of course, there are areas where mental health support is just not available. Small volunteer agencies can struggle with providing resources and services. That population in particular may suffer even more as they are typically in smaller communities, serving their friends and neighbors when responding to calls.

So how can we get more EMS providers to access mental health services more often? Here are a few things that we can do to help our brothers and sisters stay healthy.

Education is key

As with most challenges, the first step is recognizing that we have a problem. Educating ourselves and those around us as to what a degradation of mental health looks like, and why it may be job-related is important. For ourselves, recognizing signs we are struggling can be a big hurdle.

Teaching others to look for things like an increase in alcohol use, withdrawing from social situations or a loss of enjoyment of hobbies can help someone check on a coworker, especially when the coworker may not even recognize what is bothering them. Periodically providing refreshers for this training will help keep it at the forefront.

One organization near our program has a great training program for family members of new employees. On the last day of their onboarding, they invite family members to come to the station. There, they are educated about what to look for in terms of signs of unhealthy levels of stress. They learn what is normal and abnormal behavior, so that not only can they keep an eye on their loved one and encourage them to seek help when needed, but they can also recognize when they may have had a rough shift and just need some grace to process it. After all, many of us try to protect our family from the negative events we see by saying nothing about them at all to the ones we’re closest to.

Peer support providers can trust

I am a big proponent of peer support teams, but they must be appropriately trained to be effective. Only 12% of respondents to the 2024 EMS Trend Survey strongly agree that their peer support team is well trained. A poorly trained team can be detrimental to someone’s well-being and therefore it is imperative to be cautious when designing and managing these programs.

Peer support training should be led by a mental health clinician who is familiar with the first response community. Employees should also be educated about how peer support is anonymous to help provide confidence that what they say won’t “get around.”

Seeking out regionalized support

Some regions or states may be able to offer services where there may be none available to an individual agency. Law enforcement has been addressing mental health for some time and there may be resources available through your local police department. Some state agencies can also have resources in place that you may be able to access. Ask neighboring agencies what resources they use. This can also be useful for those smaller agencies whose employees might not want to talk to their peers.

While EMS agencies have made leaps and bounds in efforts to ensure the physical and mental well-being of their staff, it will take all of us to affect real change. EMS providers must put a focus on their own health throughout their careers. By putting some of these pieces together, we can continue to move forward with extending not only our careers, but our lives overall. 

Download the full digital edition: What Paramedics Want 2024

About the Author

Joe Coons is the director of safety and Communications Center manager at LifeFlight Eagle, a not-for-profit air medical service serving Northwest Missouri. His journey with LifeFlight Eagle started in 2005, when he embarked on his career as a dedicated flight paramedic.

With more than 32 years of experience in EMS, Joe brings invaluable support to the program, imparting training in critical areas such as human factors, root cause analysis and the implementation of a just culture. His commitment and leadership were recognized when he was honored with the prestigious David Connelly Memorial Leadership Award in the Communications Center Manager’s Course in Spring 2018.

Leveraging telehealth as a part of normal practice can actually help save time, preserve resources, and increase the output of smaller crews. Here's how.