Predictors of posttraumatic stress and preferred sources of social support among Canadian paramedics
Open accessAbstract
Objective Emergency medical service (EMS) providers are exposed to a variety of stressors endemic to the profession. These exposures may contribute to stress reactions, including posttraumatic stress. The objective of this study was to evaluate the relationship between work-related stressors and posttraumatic stress. The secondary objective was to determine paramedics' preferred sources of support for managing work-related stress.Methods 269 paramedics in a county-based EMS service were invited to complete an online survey. Respondents reported their demographic characteristics, levels of chronic stress, critical incident stress, posttraumatic stress symptomatology (PTSS), and preferred sources of support for managing work-related stress.Results A total of 145 paramedics completed the survey. PTSS was significantly correlated with operational stress (p<0.001), organizational stress (p<0.001), and critical incident stress (p<0.001). Regression models revealed that chronic operational stress was a significant independent predictor of PTSS (p<0.001) and in combination with critical incident stress (p<0.01). Paramedics reported a higher preference for receiving support from a work partner, friend, or family member than from other sources (p<0.001).Conclusion Both chronic and critical incident stressors appear to be significant predictors of PTSS. Our findings suggests that holistic health and wellness initiatives that address the impact of both critical incident stress and the chronic stressors associated with day-to-day operations may help mitigate PTSS. Our findings also provide preliminary evidence that interventions may benefit from a focus on peer support and on friends and family members who can support the affected paramedic.
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In a smaller Canadian sample, operational stress, both independently and interacting with critical incident stress, was a significant predictor of posttraumatic stress.
“The results were partially replicated in a smaller sample in the Canadian context, where operational stress, both independently and interacting with critical incident stress, was a significant predictor of posttraumatic stress [36].”
From Assessing the Relative Impact of Diverse Stressors among Public Safety Personnel (2020) · cites this paper as [36]
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“…higher risk for experiencing strong negative emotions (e.g., fear, worry), and disturbed sleep or concentration (e.g., Van Der Ploeg and Kleber, 2003; Benedek et al., 2007; Halpern et al., 2009; Donnelly et al., 2016), which in turn promotes the development of physical and mental health problems.”
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MethodThe risk factors Finnish paramedics recognize when performing emergency response driving
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“Discussion 100% (11) 93% (13) 63% (126) 81% (202)”
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“Whereas previous studies have found higher rates of mental disorders among advanced care paramedics [67] and protective effects of higher education [9,63] and being in a relationship [9,63], our findings did not bear this out.”
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“The wider population risk factors for PTSD and psychiatric morbidity also apply to paramedics (3-6), including being younger, female and less educated (15,16), although this has not been found consistently (17,18).”
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“We identified a total of 60 reports exploring paramedic physical health [36,37], safety [38,39], mental health [40,41], violence against paramedics [42], mental health supports and interventions [43], and family and social supports [44].”
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Health behaviours in ambulance workers
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“11,12 Both acute and chronic work-related stress exposure have been associated with the development of posttraumatic stress symptomology 9,11 and burnout 13,14 and likely contribute to the signi fi cantly higher suicide mortality odds ratios of EMS clinicians compared with the general public.”
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“3,6,23 This peer support seems to be most bene fi cial when integrated directly into the standard operations and infrastructure of the agency 24 and when it occurs immediately after the acute crisis event 17,23 ; it offers the opportunity for a brief time-out period to casually talk about the event…”
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“…and colleagues play a key role in promoting and supporting paramedics ’ wellbeing and mental health and for many paramedics, this is often their preferred method of support compared to that of supervisors, employee assistance, or professional services (Donnelly et al., 2016; Regehr & Millar, 2007).”
Fatigue based on the subjective feeling of people representing selected medical professions
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“This is contrary to the report by Donnelly et al. [23], who in this occupational group noted an increase in stress resulting from exposure to aggravating and dangerous factors proportionally to the increase in seniority.”
ResultOrganizational strategies to address posttraumatic stress injuries among Canadian paramedics
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“In addition, increasing evidence suggests that organizational factors play a significant role in preventing and managing PTSI in the workplace and supports the development and implementation of organizational-wide strategies [5, 11, 13–19].”
Personality, social support, stress, and coping in a sample of Canadian paramedics
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“Finally, the University of Windsor ’ s Elizabeth Donnelly has led initiatives designed to understand work role identity and has developed paramedic-speci fi c instruments for measuring the stressor – stress process (for example Donnelly, 2012; Donnelly et al., 2016; Donnelly & Siebert, 2009; Donnelly et al., 2015).”
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Drewitz-Chesney, C. (2019) · Australasian Journal of Paramedicine · doi:10.33151/ajp.16.714 · Cited by 4 · see citing works
“The few studies exploring paramedic peer support have typically defined “peers” as partners, coworkers and even supervisors (3,47).”
BackgroundChan, S. C., Jenkins, J. L., Zhang, A. W., Everly, G. S., Roemer, E. C., Hsu, E. B., Han, G., Sharma, R., Asenso, E., Bidmead, D., et al. (2025) · Journal of Emergency Medicine · doi:10.1016/j.jemermed.2025.09.004 · Cited by 6 · see citing works
Physiological and psychological components of paramedic wellbeing
Wheeler, B., & Dippenaar, E. (2020) · International Paramedic Practice · doi:10.12968/ippr.2020.10.2.33 · Cited by 3 · see citing works
Mausz, J., Jackson, N., Lapalme, C., Piquette, D., Wakely, D., & Cheskes, S. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19053004 · Cited by 3 · see citing works
“Finally, attending calls for patients with life-threatening illness has been cited in several studies as an example of a critical incident [31,49–51], exposure to which is associated with an increased risk of post-traumatic stress disorder (PTSD) among paramedics [49,52].”
BackgroundSecondary traumatic stress in partners of paramedics: A scoping review
Hill, M. A., Paterson, J. L., & Rebar, A. L. (2023) · Australasian Emergency Care · doi:10.1016/j.auec.2023.06.002 · Cited by 3 · see citing works
HASTANE ÖNCESİ ACİL SAĞLIK HİZMETLERİ ÇALIŞANLARINDA MOBBİNG
Uyanık, E. (2024) · Hastane Öncesi Dergisi · doi:10.54409/hod.1395873 · Cited by 3 · see citing works
How to Better Value EMS Clinicians as Key Care Team Members
Torres, A. J., & McCoy, R. G. (2022) · The AMA Journal of Ethic · doi:10.1001/amajethics.2022.898 · Cited by 3 · see citing works
‘Giving a piece of you’: the lecturer experience of aiding student wellbeing
Pavoni, K., & Phillips, L. (2022) · Journal of Paramedic Practice · doi:10.12968/jpar.2022.14.5.188 · Cited by 3 · see citing works
Prevalence and Characteristics of Violence Against Paramedics in a Single Canadian SitePreprint
Mausz, J., Johnston, M., Arseneau-Bruneau, D., Batt, A. M., & Donnelly, E. A. (2023) · Preprints.org · doi:10.20944/preprints202307.1037.v1 · Cited by 3 · see citing works
Alshahrani, K. M., Johnson, J., Alzahrani, A., & O'Connor, D. B. (2025) · Emergency health services journal. · doi:10.4103/ehsj.ehsj_3_25 · Cited by 2 · see citing works
Geuzinge, R., Visse, M. A., Duyndam, J., & Vermetten, E. H. G. J. M. (2024) · SAGE Open · doi:10.1177/21582440241297958 · Cited by 2 · see citing works
“Existing research found, for example, amongst para-medics and volunteer firefighters, that social support preferably arises from extra-occupational sources, such as family, friends, and the community (Donnelly et al., 2016; Huynh et al., 2013).”
Comparing Cognitive Performance, Mood and Emotion Regulation in Firefighters with and without PTSD
Shavaran, R., & Tavakoli, M. (2020) · doi:10.22034/ijpb.2020.217137.1148 · Cited by 1 · see citing works
Maloney, L. M., Robitsek, R. J., McKenzie, K., Peralta, E., & Valenzuela, J. Y. (2024) · Air Medical Journal · doi:10.1016/j.amj.2024.03.006 · Cited by 1 · see citing works
Leadership characteristics to reduce staff attrition and absence related to burnout
Paterson, S. (2024) · Journal of Paramedic Practice · doi:10.12968/jpar.2023.0009 · Cited by 1 · see citing works
Sitko-Dominik, M. M., Jakubowski, T. D., & Mandal, E. (2025) · International Journal of Occupational Medicine and Environmental Health · doi:10.13075/ijomeh.1896.02545 · Cited by 3 · see citing works
“Bearing it in mind, despite some potential benefits of talking to their fellow paramedics about what they experience and de-claring the wish to get support from co-workers, friends or family members, they may choose not to do so under real circumstances [4,35].”
Occupational stress in emergency medical services
Budimski, M., Momirović-Stojković, M., Gavrilović, N., & Jakšić-Horvat, K. (2017) · ABC - časopis urgentne medicine · doi:10.5937/abc1701001b · Cited by 1 · see citing works
Responding to catastrophe: Learning from perinatal death in midwifery practice
Laing, R. E. (2018) · Murdoch University Research Portal
Development and Psychometric Properties of Prosocial Behaviour Scale for Rescue Workers
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Leadership characteristics to reduce staff attrition and absence related to burnout
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Sense of community and its relationship to emotional detachment in Australasian paramedics
Hocking, S., & Asbury, E. (2024) · Paramedicine · doi:10.1177/27536386241306140
“12 – 14 This study therefore adopted McMillan and Chavis ’ Sense of Community theory 15 as a framework to measure paramedics ’ connections with each other and to provide a basis for investigating any correlations with emotional detachment scores.”
InfluentialMakgolo, R., Havenga, Y., & de Villiers, M. (2025) · Occupational Health Southern Africa · doi:10.62380/ohsa.2025.31.1.3
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Burnout, Stress, and Moral Injury Among Emergency Medical Services Clinicians: A Systematic Review
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Paramedic perspectives on workplace peer support: a thematic analysis
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“…mental health stigma, promote help-seeking, and normalise adverse experiences (Anderson et al., 2020; Fallon et al., 2023), and on face value the peer-to-peer delivery aligns with paramedic preferences for collegial support (Donnelly et al., 2016; Loudoun et al., 2020; Warren-James et al., 2022).”
Supporting Mental Health in EMS Clinicians: A NAEMSP Position Statement and Resource Document
Lulla, A., Crowe, R. P., Donnelly, E. A., Isaacs, S. M., Lincoln, E. W., Maloney, L. M., Miller, D., Morshedi, B. B., Svancarek, B., & Dorsett, M. (2026) · Prehospital Emergency Care · doi:10.1080/10903127.2026.2740139
- Authors
- Donnelly, E. A., Bradford, P., Davis, M., Hedges, C., & Klingel, M.
- Affiliations
- University of Windsor (CA)
- Western University (CA)
- Corresponding author
- Donnelly, Elizabeth A.
- Venue
- CJEM
- Published
- 2015-09-01
- Volume
- 18
- Issue
- 3
- Pages
- 205-212
- ISSN
- 1481-8035 (ISSN-L)
- 1481-8043
- OpenAlex
- W2098864767
- Cited by
- 71
- References
- 47
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 11 · 2023: 9 · 2022: 19 · 2021: 3 · 2020: 8 · 2019: 4 · 2018: 4 · 2017: 2
- FWCI
- 2.48
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Canadian Journal of Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Performance
- Keywords
- post-traumatic stress, paramedics, emergency medical services, occupational stress, critical incident stress, social support, peer support, occupational stressors
- MeSH terms
- Adult, Allied Health Personnel, Female, Humans, Male, Ontario, Surveys and Questionnaires, Risk Factors, Social Support, Stress Disorders, Post-Traumatic, Checklist
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