By Henrietta Van hulle

A career in paramedic service is, with no question, a job that has high risk of psychological harm for its workforce.  Ontario’s 11,000 paramedics, 1,200 ambulance communication officers and more than 2,000 support staff are among these workers who face potential occupational mental health injury.

Seeing the risk of psychological harm to the paramedic service, the Public Services Health & Safety Association (PSHSA) dove into the highest risk and the “why” behind the risk and start looking at impactful solutions to minimize those risk factors. In 2021-2022, the process began with a meeting of stakeholders, to try to understand the associated risks and root causes, and develop solutions to mitigate, control or eliminate these risks.

A two-part investigative process

The two-part process required the perspective of stakeholders including, worker and management representatives from Ontario’s land and air ambulance services, representatives serving First Nations, urban, rural and remote communities, individuals with lived experience, clinicians, health and safety professionals and representatives from academia and provincial government.  This group came together with the common goal to identify the occupational health and safety hazards that workers in paramedic services are most exposed to, and uncover recommendations that represent a balance of perspectives.

Part One: Risk Assessment – What keeps you up at night?

In Fall 2021, the project participants were asked the question, “What keeps you up at night?”  And the group answered with 105 hazards paramedics face in the workplace.

The group then rated each hazard according to its likelihood and consequence to determine the overall risk rating for all hazards. Of the 105 hazards, 48 were found to be high-risk, 54 medium-risk and 3 low-risk. Post-traumatic stress disorder injuries were identified as the top hazard. Risks involving ambulance design, equipment concerns, workplace violence, traffic protection and fatigue rounded out the top ten.

Part Two: Root Cause Analysis – Psychological harm

Following the risk assessment, a report was provided to Ontario’s EMS Section 21 Sub-Committee to review the top ten hazards from the first phase of the project. The committee selected the top identified hazard – psychological harm – to be explored in the second project phase beginning in Winter 2022.

Part two of the project had participants come together for a two-day deep dive look at psychological harm risk factors, focusing on front line paramedics and ambulance communication officers.  The group looked for hazard factors that have the potential for causing psychological harm and looked for the root cause of those hazards.  Thirty-six causes fundamental to the elimination and control of exposures that could lead to psychological harm for paramedic service workers were identified. Project participants then used a scale rating system, to determine the top 11 causal factors.

On the second day, the group looked at those identified 11 factors and brainstormed 150 unique solutions and controls and identified possible interventions to reduce the risk of psychological harm to workers.

The following themes emerged from the proposed solutions.

• Updating training (i.e., materials, facilitation, time allotted, methods) for workplace violence, psychological health and safety, fatigue, handling traumatic events, stigma, self-care, stay-at-work and return-to-work, and resiliency
• Providing trauma-informed and paramedic-specific mental health support
• Increasing collaboration between educational institutions, base hospital programs and service providers on training, mentorship and program development
• Allowing for protected or dedicated time for training and continuing education, breaks and operational pause time to reset and re-energize
• Highlighting the need for paramedic-specific health and safety legislation in addition to increased participation from, and consultation with, paramedic service workers when there are system or legislative changes.
• Continuing forums and workshops where various workplace parties and decision makers can focus on issues and brainstorm solutions; and encouraging self-care at the service level by enhancing facilities (e.g., gyms, break rooms, quiet spaces), and spreading awareness.
• Engaging family support systems, looking at how family members can be part of the solution, bringing awareness of risk factors, signs and symptoms their paramedic worker might face, and feeling empowered to know where to look for supports for the worker and themselves.

Next steps

The participants at the table presented cogent, thoughtful and well-reasoned solutions to the hazards faced by Ontario’s paramedic service. Some of the recommended solutions or controls represented quick wins that are relatively simple to implement in a short period of time, while others are system-level changes that require support and coordination from multiple stakeholders, and some may not be feasible. Each recommendation identified those (i.e., ministries, organizations, associations) with the potential to implement solutions.

I would encourage system change makers to review these proposed solutions and control measures and consider collaborating with others identified to determine the viability of, and best practices for, implementing these recommendations. This project will inform PSHSA’s work within the sector for years to come.

The final reports for both project phases, including detailed additional background, methodology, and findings can be accessed at www.pshsa.ca/paramedicproject.

Henrietta Van hulle is Vice President, Public Services Health & Safety Association