First Responder Wellness Research

We've been talking about burnout in EMS for decades.

Burnout is often discussed as though it's a new problem brought on by recent workforce shortages or the COVID-19 pandemic.

The truth is...

Researchers were documenting burnout among paramedics nearly 40 years ago.

In 1988, Grigsby and McKnew published one of the earliest studies examining work-related stress and burnout among paramedics. Their findings demonstrated that the emotional demands of EMS were already taking a significant toll on those answering the call.

While the profession has evolved, many of the challenges identified then remain familiar today.

🚑 Chronic occupational stress

😓 Emotional exhaustion

⚠️ High operational demands

💔 Compassion fatigue

👥 Staffing challenges

⏰ Long hours and irregular schedules

The message is clear:

Burnout isn't a new problem. It's a long-standing occupational hazard.

For decades, EMS professionals have adapted, persevered, and continued to provide exceptional care despite working in environments that often ask them to give more than they have to give.

The encouraging news is that our understanding of burnout has grown considerably since 1988.

Today we know burnout is not simply an individual weakness or a lack of resilience.

Research consistently shows it is influenced by the interaction between job demands and organizational resources, including staffing, leadership, workload, recognition, support, autonomy, and workplace culture.

That means burnout is something organizations can help prevent—not just something individuals are expected to overcome.

As someone whose research focuses on preventive mental wellness for first responders, I think this article serves as an important reminder:

We've known burnout has been a problem for nearly four decades.

The question is no longer whether burnout exists.

The question is what are we willing to do about it?

💬 For those who have been in EMS for many years—what has changed, and what hasn't?

**Article Citation:**
Grigsby, D. W., & McKnew, M. A. (1988). *Work-stress burnout among paramedics.* *Psychological Reports, 63*, 55–64. https://doi.org/10.2466/pr0.1988.63.1.55

What exactly is moral injury—and how do we measure it?

As conversations about first responder and military mental health continue to evolve, **moral injury** has become an increasingly important topic. But before we can understand it, treat it, or study it, we need reliable ways to measure it.

A 2025 systematic review and meta-analysis by Griffin and colleagues examined the outcome measures used to assess moral injury across research and clinical settings.

The review found that while multiple assessment tools exist, they differ in what they measure, how they define moral injury, and the populations for which they were developed. This highlights both the progress made in the field and the ongoing need for consistent, validated measures.

The authors identified several common dimensions of moral injury:

⚖️ Guilt

💔 Shame

😔 Betrayal

🧭 Violations of deeply held moral values

🤝 Loss of trust

❓ Spiritual or existential conflict

Unlike PTSD, which is often rooted in fear after a traumatic event, moral injury centers on violations of one's moral beliefs or values. It may occur after actions taken, actions not taken, or feeling betrayed by leaders or organizations.

The review also emphasized that measuring moral injury accurately is essential for:

✅ Advancing research

✅ Improving clinical care

✅ Evaluating treatment effectiveness

✅ Better understanding first responder and military experiences

As someone whose work increasingly focuses on preventive mental wellness and moral injury among first responders, I find this review especially valuable. It reminds us that before we can effectively address a problem, we must first understand how to identify and measure it.

As research continues to evolve, so will our ability to recognize moral injury earlier, provide more targeted interventions, and build healthier organizations.

💬 Do you think moral injury is receiving enough attention in first responder wellness discussions?

**Article Citation:**
Griffin, B. J., Price, L. R., Jenkins, Z., Litz, B. T., & Maguen, S. (2025). *A systematic review and meta-analysis of moral injury outcome measures.* *Current Treatment Options in Psychiatry, 12*(1), Article 7. https://doi.org/10.1007/s40501-024-00342-9

Roll Call...I'd love to hear from you! 👋

Over the past 7 years, life has taken me on quite the journey. I've had the opportunity to call four states home:

📍 New Orleans, Louisiana
📍 Memphis, Tennessee
📍 Texarkana, Texas
📍 Morgantown, West Virginia (where I currently live)

I'm curious...who on this page is from one of these places?

Drop a comment below and tell me:

📍 Which city or state you're from.

If we've met before, I'd love to hear that too! Let me know where we met and when—whether it was through EMS, counseling, teaching, research, a conference, or somewhere else.

One of my favorite parts of this page has been reconnecting with old friends and making new connections with people who are passionate about supporting first responders and military communities.

I can't wait to see where everyone is checking in from!

👇 Say hello in the comments!

Send a message to learn more

Can training supervisors improve employee mental health? The research says yes.

When we talk about workplace mental health, we often focus on helping employees. But what if one of the most effective interventions is equipping leaders with the knowledge and skills to support their teams?

A 2018 systematic review and meta-analysis by Gayed and colleagues examined whether training workplace managers to better understand and respond to employee mental health needs makes a difference.

The answer was encouraging.

Across multiple studies, the researchers found that mental health training improved managers' knowledge, confidence, and supportive behaviors, helping them better recognize when employees may be struggling and respond more effectively.

Training helped supervisors:

👥 Better recognize signs of psychological distress

🗣️ Feel more confident having conversations about mental health

🤝 Provide appropriate support and referrals

📚 Increase their understanding of common mental health conditions

🏢 Foster healthier workplace cultures

One of the most important findings is that managers don't need to become therapists.

They need to become leaders who recognize concerns early, respond with empathy, and connect employees to appropriate resources.

For first responder organizations, this finding is especially important.

Supervisors are often the first to notice changes in behavior, performance, attendance, decision-making, or interactions with coworkers. When leaders are trained to respond appropriately, they can help reduce stigma, encourage early intervention, and create a culture where seeking help is viewed as a strength—not a liability.

This aligns closely with my own work developing preventive mental wellness training for first responder leaders. Leadership is more than managing operations; it is creating an environment where people can perform at their best while knowing their well-being matters.

Strong leaders build strong organizations.

Healthy leaders help build healthy first responders.

💬 If you could add one mental health skill to every supervisor's leadership toolbox, what would it be?

**Article Citation:**
Gayed, A., Milligan-Saville, J. S., Nicholas, J., Bryan, B. T., LaMontagne, A. D., Milner, A., Madan, I., Calvo, R. A., Christensen, H., Mykletun, A., Glozier, N., & Harvey, S. B. (2018). *Effectiveness of training workplace managers to understand and support the mental health needs of employees: A systematic review and meta-analysis.* Occupational and Environmental Medicine, 75(6), 462–470. https://doi.org/10.1136/oemed-2017-104789

I love meeting leaders who are willing to challenge the status quo and create meaningful change for first responders.

I'm excited to be working with a police chief who wants to implement my blueprint for a proactive approach to first responder wellness, moving beyond the reactive models that have too often become the norm. Rather than waiting until someone reaches a crisis, this approach focuses on building a culture of prevention, early intervention, and organizational support.

This blueprint wasn't created overnight. It has been shaped by years of research, countless conversations with first responders and leaders, collaboration with mental health professionals, and my own experiences serving as a paramedic. Every piece has been developed with one goal in mind: helping first responders stay healthy throughout their careers, not just responding after they're struggling.

The best part? We're not stopping at implementation. We'll be collecting data throughout the process to evaluate outcomes, measure effectiveness, and continue refining the model so it can be replicated in agencies across the country.

This is exactly why I do this work. Real change happens when research meets leadership, and when leaders are willing to invest in the people who serve their communities every day.

I'm incredibly excited for what's ahead, and I can't wait to share this journey with all of you.

How does repeated trauma change the way paramedics see the world?

This question was explored more than 20 years ago by Galloucis, Silverman, and Francek, and despite its age, the findings remain highly relevant today.

The researchers examined how repeated exposure to traumatic events influences the cognitive schemas—the deeply held beliefs and assumptions people have about themselves, others, and the world—of paramedics.

Rather than affecting only emotions, repeated trauma can gradually change how a person interprets everyday experiences.

The study suggested that chronic trauma exposure may alter beliefs about:

🧠 Safety – Is the world a safe place?

🤝 Trust – Can I rely on other people?

⚖️ Control – Can I influence what happens?

❤️ Intimacy – Can I connect with others without getting hurt?

💭 Self-worth – Am I enough? Did I do enough?

Over time, repeated exposure to suffering, violence, death, and tragedy can shift these beliefs in subtle ways.

A paramedic who once saw the world as generally safe may begin expecting danger.

Someone who once trusted others may become increasingly skeptical.

Someone who entered EMS to save lives may begin questioning whether their efforts truly make a difference.

This doesn't mean every first responder will experience these changes—but it reminds us that trauma is not only about what we remember.

It can also influence how we see ourselves and the world around us.

One reason I appreciate this article is that it helped shift the conversation from asking "What's wrong with first responders?" to "How has the work changed them?"

That distinction matters.

Understanding these cognitive changes allows clinicians, peer supporters, and leaders to better recognize the long-term effects of repeated trauma and support healthier recovery.

Although this article was published in 2000, its message continues to resonate with today's research on cumulative trauma, PTSD, moral injury, and resilience.

💬 Have you noticed your perspective on the world change over the course of your career?

**Article Citation:**
Galloucis, M., Silverman, M., & Francek, H. (2000). *The impact of trauma exposure on the cognitive schemas of a sample of paramedics.* *International Journal of Emergency Mental Health, 2*(1), 5–18.

Why are EMS clinicians leaving the profession?

Every EMT and paramedic who leaves EMS represents more than a vacant position. They take with them years of experience, clinical judgment, mentorship, and knowledge that are difficult to replace.

A recent national study by Gage and colleagues sought to better understand the factors associated with EMS clinicians' intentions to leave the profession. Their findings highlight an important message for EMS leaders: while stress and the COVID-19 pandemic continue to influence workforce decisions, **job satisfaction was the strongest factor associated with the likelihood of leaving EMS.**

The study found that the most commonly reported reasons for considering leaving EMS included:

🚑 Increased occupational stress

🦠 Lasting impacts of the COVID-19 pandemic

📉 Job dissatisfaction

🎓 Pursuing additional education (particularly among EMTs)

The researchers also found differences based on agency type. Clinicians working for hospital-based, private, and non-fire government EMS agencies were more likely to report intentions to leave than those working within fire-based EMS systems.

These findings reinforce something many EMS professionals have been saying for years:

Retention isn't just about recruitment.

It's about creating workplaces where people want to stay.

Competitive pay matters. Career advancement matters. Mental health support matters. Leadership matters. Feeling valued matters.

As someone whose research focuses on preventive mental wellness and workforce sustainability, I believe improving retention requires addressing both **individual well-being** and **organizational culture**. Healthy clinicians are more likely to remain in the profession when they also work in healthy organizations.

Supporting EMS professionals isn't just an investment in employees—it's an investment in patient care, organizational stability, and the future of emergency medical services.

💬 In your opinion, what is the single biggest factor driving experienced EMS clinicians to leave the profession?

**Article Citation:**
Gage, C. B., Cooke, C. B., Powell, J. R., Kamholz, J. C., Kurth, J. D., van den Bergh, S., & Panchal, A. R. (2025). *Factors associated with emergency medical clinicians leaving EMS.* *Prehospital Emergency Care*. https://doi.org/10.1080/10903127.2024.2436047

**Should mental health counseling be required for EMTs and paramedics?**

This question was explored in a 2022 article by Sarah Fader, and it continues to generate strong opinions throughout the EMS profession.

EMTs and paramedics routinely encounter situations that most people will never experience:

🚑 Serious injuries

🚑 Death and dying

🚑 Child fatalities

🚑 Violence

🚑 Human suffering

🚑 High-pressure decision-making

🚑 Long shifts and sleep disruption

Given these occupational realities, some have argued that regular mental health counseling should be viewed similarly to physical fitness, continuing education, or clinical competency training—a proactive component of professional wellness rather than a response to crisis.

The article discusses potential benefits of counseling for EMS professionals, including:

✅ Stress management

✅ Emotional processing

✅ Burnout prevention

✅ Improved coping skills

✅ Early identification of mental health concerns

✅ Increased resilience and career longevity

At the same time, the question of *required* counseling remains complex.

Some EMS professionals support the idea because it normalizes mental health care and removes stigma.

Others raise concerns about:

⚠️ Personal choice

⚠️ Confidentiality

⚠️ Cost and accessibility

⚠️ Workforce shortages

⚠️ Organizational trust

Perhaps the most important takeaway is that mental health care should not be viewed as something reserved only for people who are struggling.

Just as we maintain ambulances before they break down, there is value in maintaining our mental health before we reach a crisis point.

As someone whose research focuses on preventive approaches to first responder wellness, I believe this conversation is worth having. We have spent decades asking first responders to manage extraordinary stressors. The question now becomes:

**What responsibility do organizations have to proactively support the mental health of those who serve?**

💬 What do you think? Should counseling be required, strongly encouraged, or entirely voluntary for EMTs and paramedics?

**Article Citation:**
Fader, S. (2022). *Should mental health counseling be required for all EMT/Paramedics?* BetterHelp.