First Responder Wellness Research

🚑 Having support matters—but believing that support is available may matter even more.

Ambulance personnel routinely experience traumatic events, organizational stressors, and other occupational pressures that can contribute to depression and posttraumatic stress symptoms.

Reti and colleagues surveyed 105 ambulance personnel to examine how social support related to psychological distress. The study distinguished between:

• Received support: the supportive actions someone actually receives
• Perceived support: the belief that reliable help and understanding are available when needed

The researchers found that:

• Social support predicted both depression and posttraumatic stress symptoms.
• Perceived social support had a stronger relationship with psychological distress than support actually received.
• Spouses and family members were viewed as the most supportive source.
• Gender did not change the relationship between social support and psychological distress.
• Social support did not eliminate the effects of organizational stress or direct traumatic exposure.

The findings suggest that support is not defined only by whether a program, peer team, supervisor, or family member is technically available. First responders must also believe that the support is trustworthy, accessible, and safe to use.

This has important implications for organizations. Agencies cannot simply create a resource and assume personnel will experience it as supportive. They must build trust, strengthen supervisor and peer relationships, include families when appropriate, and consistently demonstrate that asking for help will not result in judgment or retaliation.

Social support does not remove traumatic exposure or repair harmful organizational conditions—but it can be an important part of protecting first responder mental health.

Read the article:
https://doi.org/10.1037/trm0000331

Reti, T., de Terte, I., & Stephens, C. (2022). Perceived social support predicts psychological distress for ambulance personnel. Traumatology, 28(2), 267–278.

🚑 **Injury and assault should not be accepted as “just part of the job.”**

Ambulance workers face substantial occupational risks while caring for others. Data reported by NIOSH found that:

• Approximately **8–9 out of every 100 EMTs and paramedics** were treated in a hospital for an occupational injury, compared with about **2 out of every 100 workers** across other occupations.
• Many injuries involved bodily movement—particularly lifting, bending, and kneeling while caring for or moving patients.
• Exposure to blood, bodily fluids, and other harmful substances accounted for approximately **27% of reported injuries**.
• The rate of assault against ambulance workers was at least **22 times higher** than across other occupations.

The actual rate of violence may be even higher. Researchers noted that assaults are often underreported because EMS professionals may view violence as an unavoidable part of the job or experience organizational pressure to accept it.

That mindset must change.

Workplace violence, repeated injuries, and unsafe working conditions affect more than physical health. They can also contribute to stress, fear, burnout, psychological distress, and decisions to leave the profession.

Protecting EMS personnel requires reliable incident reporting, safe staffing, effective lifting and transport practices, exposure protections, violence-prevention procedures, supportive leadership, and an organizational culture that takes every assault seriously.

**Responder safety is part of responder wellness.**

Read the article:
https://ohsonline.com/articles/2019/09/03/ambulance-workers-are-more-likely-to-get-injured-and-assaulted-on-the-job.aspx

NIOSH. (2019). *Ambulance workers are more likely to get injured—and assaulted—on the job.* Occupational Health & Safety.

Connection is more than a “nice extra”—it can be a protective part of first responder mental health.

Research summarized by Hilbrink (2022) suggests that social connectedness can help reduce the harmful effects of occupational trauma and is associated with greater resilience among first responders. Important sources of connection include:

• Supportive relationships with family and friends
• Trust and cohesion within work teams
• Connection across first responder agencies
• Participation in workplace wellness programs
• A sustainable balance between work and personal life

Low-pressure social and wellness activities may also provide a “soft entry” to mental health care. A first responder who is hesitant to attend a formal mental health program may be more comfortable participating in an activity centered on connection, family, or well-being. Those relationships can help normalize conversations, identify concerns earlier, and build trust in available services.

Social connection is not a substitute for professional treatment when treatment is needed. It can, however, strengthen protective networks and make it easier for first responders and their families to access help earlier.

Mental health support should not place the entire responsibility for resilience on the individual. Agencies can create environments in which connection, trust, family inclusion, and early support are intentionally built into the system.

Read the article:
https://knowledge.aidr.org.au/resources/ajem-october-2022-the-role-of-social-connectedness-in-protecting-first-responder-mental-health-and-wellbeing/

Hilbrink, D. (2022). The role of social connectedness in protecting first responder mental health and wellbeing. The Australian Journal of Emergency Management, 37(4), 65–68.

Rural and remote first responders face many of the same traumatic exposures as their urban counterparts—but often with fewer resources, fewer personnel, and greater distance from support.

This research commentary highlights how rural and remote conditions can intensify occupational stress:

• Reduced staffing can increase workloads, fatigue, and burnout.
• Limited access to specialized personnel can make dangerous calls more difficult to manage.
• Violence, threats, and unpredictable scenes create both physical and psychological risks.
• Workforce shortages can create a cycle in which turnover increases the burden on those who remain.
• Mental health services may be limited or difficult to access once concerns develop.

The authors argue that rural first responders may require support strategies designed specifically for their working environments—not simply smaller versions of programs developed for urban agencies.

Recommendations include preventive mental health and resilience education during initial and continuing training, appropriate mental health screening, access to clinical assessment, evaluation of existing post-incident practices, and more research centered on rural first responders’ lived experiences.

Where someone serves should not determine whether meaningful mental health support is available. Supporting rural responders also means addressing staffing, workload, safety, retention, and access to care.

Read the open-access article:
https://opus.lib.uts.edu.au/bitstream/10453/173015/2/Journal%20of%20Advanced%20Nursing%20-%202023%20-%20Jones%20-%20First%20responder%20mental%20health%20%20traumatic%20events%20and%20rural%20and%20remote.pdf

Jones, R., Jackson, D., & Usher, K. (2023). First responder mental health, traumatic events and rural and remote experience. Journal of Advanced Nursing. https://doi.org/10.1111/jan.15856
Download PDF

I look forward to seeing you there!

Research supports treatment—but prevention still needs stronger evidence.

A 2025 umbrella review examined 18 systematic reviews containing 41 studies of mental health interventions for first responders. The researchers found:

• Trauma-focused cognitive behavioral therapy and EMDR had the strongest support for treating PTSD.
• Mindfulness-based interventions, imagery-based trauma-prevention training, and EMDR showed emerging potential as preventive approaches.
• Most prevention research focused on programs offered broadly to first responders.
• Very few studies examined interventions for first responders beginning to show symptoms but who had not yet developed a diagnosable condition.
• Police personnel were studied more frequently than EMS professionals, firefighters, dispatchers, and other responder groups.

The takeaway is not that we should wait until someone develops PTSD before offering support. It is that we need to strengthen the evidence for preventive programs while ensuring first responders who need treatment have access to proven, trauma-focused care.

A complete mental health system should include prevention, early identification, timely intervention, and evidence-based treatment—not crisis response alone.

Read the article:
https://doi.org/10.1037/cps0000252
Article Link

Arjmand, H.-A., O’Donnell, M. L., Sadler, N., Peck, T., & Varker, T. (2025). Prevention and treatment of mental health conditions in first responders: An umbrella review. Clinical Psychology: Science and Practice, 32(2), 163–182.

We Need to Stop Asking, "Who Got Hurt?" and Start Asking, "Why Did the System Allow It?"

When a paramedic is injured on the job, we often look for a single cause:

They lifted incorrectly.
They weren't paying attention.
They made a mistake.

But what if we're asking the wrong question?

A 2024 paper by Kearney and colleagues argues that paramedic injuries cannot be fully understood through traditional incident reporting alone. Instead, injuries should be viewed as the result of complex systems involving organizational, environmental, operational, and human factors.

The authors suggest moving beyond a linear approach to injury surveillance and adopting systems thinking—an approach that recognizes injuries rarely occur because of one isolated event. Rather, they emerge from interactions across multiple levels of the system.

For example, a lifting injury may involve:

🚑 Patient characteristics

🏠 The physical environment

⏰ Time pressures

👥 Staffing levels

📋 Organizational policies

🚒 Equipment availability

💬 Communication

🧠 Fatigue and workload

All of these factors interact to influence risk.

This perspective has implications well beyond physical injuries.

The same systems approach can help us better understand:

❤️ Burnout

🧠 PTSD

⚖️ Moral injury

😓 Fatigue

📉 Workforce turnover

🚨 Near misses

As someone whose work focuses on preventive mental wellness for first responders, this article strongly resonates with me.

If we want healthier first responders, we must move beyond blaming individuals and begin designing healthier systems.

The goal isn't simply preventing injuries.

It's creating organizations where injuries—both physical and psychological—are less likely to occur in the first place.

That's what prevention looks like.

💬 If you could change one system within your organization to make first responders safer, what would it be?

📖 Read the article here:
https://www.sciencedirect.com/science/article/pii/S0925753524000092

Citation:
Kearney, J., Muir, C., Salmon, P., & Smith, K. (2024). Rethinking paramedic occupational injury surveillance: A systems approach to better understanding paramedic work-related injury. Safety Science, 172, 106419. https://doi.org/10.1016/j.ssci.2024.106419
Download PDF

📢 Seeking Subject Matter Experts for a First Responder Wellness Research Study

I am recruiting qualified professionals to review the newly developed Preventive Resilience & Readiness Assessment Battery (PRR-AB).

The assessment tools are designed to measure:

• Leadership preparedness for workforce wellness
• Perceptions of behavioral health supports
• Organizational wellness climate within first responder agencies

I am seeking professionals with expertise in one or more of the following areas:

• Law enforcement, EMS, fire, communications/dispatch, or corrections leadership
• First responder behavioral health
• Peer support

Participation involves completing an online rating form to evaluate assessment items for relevance and clarity and provide recommendations for improvement. The review takes approximately 30–45 minutes.

Participation is voluntary, and there is no compensation.

To review the study information and participate, send me your email address as a DM for the link

Please share this invitation with other qualified colleagues who may be interested.

Questions may be directed to Joy Hutchinson, Ph.D., at [email protected].

Organizational Culture Can Determine Whether EMS Clinicians Stay or Leave

When agencies struggle with retention, the conversation often focuses on pay, staffing, or burnout.

But a 2025 national study suggests there may be another critical factor:

Organizational culture.

Kamholz and colleagues surveyed more than 30,000 EMS clinicians across the United States to examine whether the type of organizational culture within an EMS agency influenced clinicians' intentions to leave the profession.

The findings were clear.

Not all organizational cultures have the same impact on retention.

Agencies with higher turnover intentions tended to have cultures that were:

📋 Highly hierarchical – rigid structures and formal procedures.

📈 Market-driven – emphasizing competition and results.

🚀 Adhocracy – highly innovative but sometimes lacking stability and consistency.

The culture associated with the lowest likelihood of clinicians wanting to leave?

🤝 Clan Culture

A clan culture is characterized by:

✅ Strong teamwork

✅ Collaboration

✅ Mutual trust

✅ Supportive leadership

✅ Mentorship

✅ A sense of belonging and shared purpose

Rather than functioning like a bureaucracy, these organizations function more like a cohesive team where employees feel valued and connected.

For first responder leaders, this is an important reminder.

Retention isn't only about salary or recruitment.

People are more likely to stay where they feel respected, supported, heard, and connected.

As someone whose research focuses on preventive mental wellness and organizational change, I find these results especially encouraging.

They reinforce that organizational culture is not just a leadership issue—it's a wellness issue, a retention issue, and ultimately a public safety issue.

Building healthier organizations may be one of the most effective strategies we have for strengthening the EMS workforce.

💬 If you could change one aspect of your agency's culture tomorrow, what would it be?

📖 Read the article here:
https://www.mdpi.com/1660-4601/22/5/756

Citation:
Kamholz, J. C., Gage, C. B., van den Bergh, S. L., Logan, L. T., Powell, J. R., & Panchal, A. R. (2025). Association between organizational culture and emergency medical service clinician turnover. International Journal of Environmental Research and Public Health, 22(5), 756. https://doi.org/10.3390/ijerph22050756

Research continues to show that supporting first responder mental health requires more than simply telling people to “reach out.”

In interviews with firefighters, EMS professionals, law enforcement officers, and others involved in first responder mental health initiatives, researchers identified several ongoing needs:

• Mental health and self-care training throughout a first responder’s career
• Clinicians who understand first responder culture and occupational experiences
• Clear confidentiality protections for peer support
• Leaders and internal champions who actively support mental wellness
• Collaboration across departments to share resources and effective practices

The study also found that smaller and rural departments may face greater barriers to developing comprehensive programs. Regional collaboration—essentially creating “mutual aid” for mental health—may help agencies share trained peer supporters, clinicians, policies, and other resources.

First responder mental health cannot depend entirely on individuals asking for help after reaching a crisis point. It must be supported through training, trusted resources, effective policies, culturally responsive care, and organizational commitment.

Read the open-access study:
https://link.springer.com/article/10.1007/s10597-023-01121-1
Download PDF

Fisher, M. P., & Lavender, C. D. (2023). Ensuring optimal mental health programs and policies for first responders: Opportunities and challenges in one U.S. state. Community Mental Health Journal, 59, 1341–1351.