This article is reposted from JEMS.com and is written by Alanna Badgley, IAEP Local 20 President.
You can read the full, original article here.
On Christmas Eve, my husband (also a paramedic) and I drove holiday meals around to stations and outposts within our response area, which now expands through eight counties in New York. As we drove from town to town through four of those counties, we casually pointed out the locations of bad calls that we’ve had throughout our combined 27 years of EMS experience in the region.
“That’s the apartment building where the cop shot himself,” my husband pointed out at one point while sipping his peppermint tea. Shortly after, we passed that town’s high school. “Oh, and that’s where I had the kid with the nasty ankle fracture,” and I followed up with, “and where I had that save for the 17-year-old basketball player that went into cardiac arrest during a game!”
Our drive continued like this for eight hours and more than 200 miles. We pointed out the locations of bad car wrecks, bicycle accidents, cardiac arrests, gunshot wounds and stabbings. In other words, our relationship to our community is painted with the images of our neighbors’ blood. We are not alone. This is what all of us who have been in the field long enough see when we go out on what should be routine errands.
As mid-career paid providers, our survival within this ecosystem has demanded the normalization of conversations like these–ones in which we can casually mention the horrible things that we’ve seen to one another while sipping tea.
Because we debrief when we get home from work, my husband and I already know each other’s stories by the end of each day. These are the types of conversations we wouldn’t want to have with our friends and family who are not a part of the first responder community– not only because it would be hard for them to understand, but also because we wouldn’t want to burden more people we love with the horrors we see.
Suffering in Silence
Yet, the normalization amongst first responders of scenes like these is also part of what allows so many of us to suffer in silence when it becomes “too much.” Not everyone has a spouse or fellow first responder in their home that they can debrief with when they return from a rough shift. Sometimes even for those of us who do, it’s simply not enough or the heaviness starts weighing on both parties in an unhealthy way.
Often, one call, or continuous calls start to affect first responders in ways that are dangerous and one of the most difficult things is knowing the line when we are no longer “OK.”
We must continue to do better as a field to normalize that “it’s OK to not be OK.” Yes, it’s “normal” to see images of carnage in your community when you are a first responder, and it’s also normal for those things to have a profound effect on your mental health, at which point, it should also be quite normal to seek help.
New York State, in collaboration with the Benjamin Center and the Institute for Disaster Mental Health at SUNY New Paltz, recently released the “New York State First Responder Mental Health Needs Assessment,” which put numbers to the very real experiences that I’ve described above.
Results
Ninety-four percent of all surveyed first responders (yup, nearly all of us) cited “stress” as a challenge faced within our community, with 68% saying they experienced it personally, with the highest numbers amongst mid-career and paid first responders.
When asked how this stress affects their personal lives, 80% stated that this stress has a negative impact on their home life and physical health. The largest percentage of first responders who cited traumatic events as a source of stress were EMS providers and dispatchers, 64% and 67%, respectively.1
Beyond critical incidents, there are many other factors impacting the overall stress of providers in our field. The risk of injury, public perception of the profession, not enough time with friends and family, toxic work culture, shift work, overtime, and the lack of access to healthcare and mental healthcare were all also rated as high sources of stress for EMS and emergency dispatchers.1 In other words, our field is really stressed out, and there is no one solution or cure-all to address it.
Sounding the Alarm
Chronic stress, as well as the demands of the field, have led to a majority of EMS practitioners and dispatchers surveyed reporting other mental health challenges, such as burnout and anxiety. Our providers also report depression, PTSD, substance abuse, and suicidal ideation at concerningly high rates.
Sleep disturbance alone affects eight in ten first responders, with a majority of us also experiencing diminished interest in daily activities, hypervigilance, flashbacks, uncontrollable worry, persistent feelings of sadness and hopelessness, and estrangement. The study found that New York first responders are four times more likely to report suicidal thoughts than the general public.1
“Normal” is defined as the “usual, typical, average or expected.” By that definition, all of these profoundly challenging mental health symptoms are, by definition, normal for us. But normal doesn’t mean ignorable. “Normal for us” is still profoundly dangerous. For 16% of first responders1 in New York, including the police officer who died by suicide that my husband mentioned on our Christmas Eve drive, it is potentially lethal.
If it’s “normal for us” to have dangerous mental health symptoms, we must as a field also ingrain mental health support into our culture and prioritize fixing the things that cause the most stress to providers. There were a variety of recommendations on how to do this offered in the study.
These include
Policies and legislation that address the mitigation of stress in the workplace,
Mandatory annual mental health wellness checks,
Free access to wellness activities and gym memberships,
Proactive activities and programming around mental health,
The development of regional or statewide peer support networks,
A development of specific credentials for “culturally competent” therapists that specialize in first responder counseling, and,
Copay-waived access to those therapists.1
I have seen many of these recommendations work in various contexts throughout my career and I have also seen them fail when executed poorly. I am hopeful that in the years to come we will continue to expand and incorporate all of these recommendations and more into our culture, not just pick and choose what’s most convenient or easy for the budget line.
The mental wellness of our providers must be the center of gravity within any conversations about the sustainability of the EMS workforce. Every policy and every decision should be necessarily innervated by the knowledge that our providers are stressed at baseline. In other words, no decisions affecting first responders should be made without accounting for the pervasive normalcy of profound suffering in our field.
This fact is the starting point from which we must continue to say, “it’s OK to not be OK.” As we continue our work to re-build our field and workforce to be more sustainable in the long term, we must always remember to leave the appropriate space for a “normal” which is otherwise abnormal outside of our community.
About the Author
Alanna Badgley is an active duty paramedic in New York and has been in the field of EMS for 15 years. She serves as the president of IAEP Local R2-20, as well as a national vice president of IAEP/NAGE. She is the co-founder of the “Make EMS Essential” campaign and president of the EMS Sustainability Alliance.
Editor’s Note: This commentary reflects the opinion of the author and does not necessarily reflect the opinions of JEMS.
Reference
1. Jacobowitz, R., Nitza, A., Kt Tobin, K., Benjamin Center for Public Policy Initiatives, & Institute for Disaster Mental Health. (2025). New York State First Responder Mental health needs assessment. https://www.governor.ny.gov/sites/default/files/2025-02/First-Responder-MHNA-Final-Report.pdf
Comentários