911! Paramedics are essential
Written By
Anna Ding Bsc Honours Specialization in Health Sciences, Faculty of Health Sciences
Dr. Elysée Nouvet Associate Professor, School of Health Studies and medical anthropologist
At the end of a 911 call are paramedics. As an essential service, these healthcare workers carry a pivotal role in emergency service, acting as the critical link between the public and the healthcare system. During the COVID-19 pandemic, they have worked tirelessly on the frontlines against each virus wave, responding to constant calls while facing additional pandemic stressors.
Between June and August 2020, researchers at Western University and the Schulich School of Medicine and Dentistry led interview-based research with paramedics working during the height of the second wave. The goal? To shine a light on how these uniquely positioned front-line healthcare workers were experiencing and navigating the safety risks inherent to all person-to-person healthcare delivery in the midst of a public health emergency. Whereas interviews revealed that the pandemic has placed unprecedented strain on paramedics, it was also apparent that the stress and heavy mental burdens of this occupation are a permanent dimension, accepted by those who embark on it, but also have existed and gone under-appreciated long prior.
Interview participants recounted their experiences working during the early stages of COVID-19 with frustration and exhaustion. At this time, information on this new novel coronavirus was rapidly changing, and care practices and policies were being altered in parallel. For instance, the symptom list for screening positive sometimes looked different from day to day, rendering it difficult and overwhelming to stay consistently updated. This further added uncertainty over which patient was truly positive, as paramedics tried to protect their own health. It became difficult to balance their sense of professional responsibility with personal health, especially with the increased infection risk to loved ones.
Consequently, many paramedics chose to self-isolate from their families. One set up their living space in their trailer parked outside their home; another moved out of the marital bedroom indefinitely to protect their loved one.
Paramedics traditionally work heavy schedules, with a full-time medic working five days in a row. This quickly became unsustainable when compounded by the pandemic workload. One participant recalled their service hitting “level zero,” a dangerous situation where no ambulances were available to respond. This forced them to give up their breaks to continue to work. Another described an already short-staffed service as even more crippled as co-workers inevitably became sick. Combined with a prolonged state of hypervigilance and physical exhaustion heightened by the summer heat and humidity, most participants seemed resigned that exhaustion represented a seemingly unchangeable aspect of their job.
The work of paramedics is vital and undoubtedly comes with risks and stresses, but how much is too much? The World Health Organization describes burnout to be an occupational phenomenon, characterized by feelings of energy depletion, exhaustion, negativism, and increased mental distance from one’s job (WHO, 2019). The complex nature of this condition makes it hard to accurately quantify, but these elements of burnout seemed to underlie many of the words participants shared.
Multiple participants described a decreased sense of accomplishment and hopelessness when procedures became halted. Although it was in a positive effort to protect their own health, prohibiting aerosol-generating procedures made it difficult to treat patients for traditionally more straightforward concerns like shortness of breath. Simultaneously, several hypothesized there was an impact on patients and families that translated into fear of seeking healthcare during 2020. Hospitals were viewed as a hotspot for the spread. Patients suffering from chronic diseases were ignoring their pain, and chemotherapy appointments were missed in fear of being stuck at hospitals, with the result that more individuals in the community were delaying seeking assistance until needing urgent attention.
With prioritization systems and triage, procedures triggered, some paramedics felt a lack of job control as they followed protocols they personally disagreed with. When met with negative, and sometimes even violent reactions from family members who were told they would have to leave their loved ones as hospitals adopted an initial no-visitor policy, it became clear that their role as the patient-facing bridge to healthcare was even more complicated.
The negative consequences of accumulated stress was predicted by at least one participant as putting the sustainability of the paramedic workforce at risk:
I think we're kind of just being expected to keep on showing up and keep on showing up and I think kind of when this is over…you're going to see a little bit of mass exodus out of healthcare in general. Participant 17
The role of paramedics has evolved greatly in the past decades, evolving from ambulance drivers to the highly skilled workers they are today, but this is not reflected in legislation. For instance, the provincial government failed to recognize paramedics in the original “List of Essential Services,” in 2020, despite including fire and police (Ontario Paramedics Association, 2020). With the long-term heavy workload they take on, many paramedics expressed alongside explicit exhaustion, feelings of discontent and regret, especially when they felt their personal health was not being valued. This was most apparent in accounts of personal protective equipment being insufficient and needing to be rationed.
Since these interviews, there has been greater public acknowledgement over the pressing concerns within emergency services, but it is unclear if enough action has been taken to mitigate and address the impact of COVID-19. While now in the midst of the sixth pandemic wave, there are new unique challenges. Toronto Star reported that paramedics who are already understaffed in rural regions are now tasked with transporting patients from city hospitals (Lightfoot, 2021). Waterloo paramedics have worked this entire pandemic without the security of a contract (Eppel, 2021).
The struggles expressed in these interviews seem widespread across Canada, and paramedic chiefs across the country in Manitoba and British Columbia have begun to publicly advocate for their team (Dacombe, 2022 and Charlebois, 2022). They face their own additional burdens while bearing the responsibility of managing their service.
Compassion fatigue, burnout and multiple other mental health-related issues are real and will have a devastating domino effect on public health if not addressed. A 911 call is lifesaving, but it relies on the resilient individuals at the end of the line who continue to work, despite all challenges.
References
Charlebois, B. (2022, January 25). Paramedics, dispatchers call for more resources as mental health issues spike. CP24 News. https://www.cp24.com/news/paramedics-dispatchers-call-for-more-resources-as-mental-health-issues-spike-1.5753279
Dacombe, S. (2022, January 26). Local paramedics talk burnout, staff shortages. The Star. https://www.thestar.com/news/canada/2022/01/26/local-paramedics-talk-burnout-staff-shortages.html
Eppel, B. (2021, June 28). Local paramedics seeing high turnover, burnout after more than a year without contract. City News. https://kitchener.citynews.ca/local-news/local-paramedics-seeing-high-turnover-burnout-after-more-than-a-year-without-contract-3912734
Lightfood, S. (2021, May 26). ‘It is not an easy job:’ Toronto paramedics reflect on the challenges of working during the pandemic. CTV News. https://toronto.ctvnews.ca/it-is-not-an-easy-job-toronto-paramedics-reflect-on-the-challenges-of-working-during-the-pandemic-1.5443859
Ontario Paramedics Association. (2020, March 25). Ontario Paramedics – not essential? https://www.ontarioparamedic.ca/news-and-events/essential
World Health Organization. (2019, May 18). Burn-out an “occupational phenomenon”: International Classification of Diseases. https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases
Photo by Erik Mclean on Unsplash
