“What’s the WORST thing you’ve EVER seen”

I love my job. I’m certainly proud of it and I love it when people ask me what I do for a living. But there is one question I get asked that I struggle with.

The conversation normally goes along the lines of this:

Joe Bloggs: So, what do you do for a living?
Me: I’m a paramedic
JB: Oh, that’s pretty cool! You must really enjoy it?
Me: Yeah I love it!
JB: Cool. So, what’s the WORST thing you’ve EVER seen???!!!!

Me: …

I get it, and I’d probably ask the same thing before I was a paramedic! Paramedics do a job that people find curious. It seems exciting and all paramedics will have some fantastic stories up their sleeves that are great at dinner parties (well, actually, maybe not at dinner parties, or generally when people are eating). But I’ve been asked this question a lot of times, and the way I hear it in my head is like this:

“Please re-live the most traumatic and harrowing event you’ve encountered in your life”.

I still haven’t come up with a good answer.

I know people don’t mean it like that, and its probably more of a case of a poorly worded question than a sadistic request.

The day to day job of a paramedic is a lot more mundane than people might expect. We deal with more and more urgent and non-emergency cases. But, it’s still a bloody hard job. The job of a paramedic is one of unpredictability. Though only a small percentage of the incidents we attend, we are still exposed to events such as the death of a child, the abuse of children, the elderly and other vulnerable groups, murders, suicides, terrorist attacks and natural disasters¹. In Regehr’s study², all 86 paramedics involved had been involved in an “emotionally traumatic event”, which the authors defined as the death of a patient, line-of-duty death, violence against self or others, near-death experience, death of a child, and multiple casualties. And, throughout all of this, paramedics are expected to keep a level head, act professionally and provide the highest clinical care we can.

Added to this, paramedics, like all jobs, have work related and occupational stress. It’s no secret that the NHS is under immense strain from every possible direction. This goes for the ambulance service too.

Targets. The much maligned 8-minute target to respond to emergency calls is like a constant internal stop-watch that’s impossible to beat every time. Hospital turn-around times, mobilisation times, response times, compliance of paperwork and care bundles, patient clinical outcomes, Key performance indicators. Targets.

Although shift work was something that lured me to the profession and is still an aspect of the job I enjoy (ask me in 10 years), it takes its toll physically and emotionally. 12 hour shifts, working nights and a lack of routine all mess with your circadian rhythm, your eating habits (try sticking to your diet through your 3rd night shift in a row) and the amount of time spent with your family. Then there is always the dread of an email coming through to say you have received a complaint, or an incident you were involved in is being investigated (even if it’s not your part in it that’s being questioned!).

Lets not even start on trying to do a PhD on top of all of it.

So then, it is no surprise that staff and volunteers working for the emergency services are at greater risk of experiencing a mental health problem, but are less likely to receive support (Mind charity). Levels of stress, anxiety and depression do vary across the literature, but have been found to be as high as 20% for PTSD, 10% for depression and 22% for anxiety³.

And, while the ambulance service attend a lot of jobs to help people having mental health issues, historically the mental well-being of staff has been overlooked. Fortunately, the mental health of emergency service staff has been getting more attention recently. The mental health charity Mind have been given funding to set up the Blue Light Programme, to provide mental health support for emergency services staff and volunteers, from police, fire, ambulance and search and rescue services across England. The Ambulance service I’m employed by provide counselling and listening services, a chaplaincy team and have also recently introduced Trauma Risk Management (TRiM) (developed by the armed forces) to support staff that may be suffering with PTSD. There are also a range of ‘Healthy Living’ apps available to staff.

I’ve been a paramedic for a relatively short amount of time, and despite all of the stresses mentioned above, I still couldn’t imagine doing and enjoying any other job as much as this at this moment of my life. I try to be mindful of my own mental well-being and I’ve noticed a few times in my career where I’ve felt like I need to take a proactive stance before things get worse. What that involves will be different for everyone. For me, it involves clearing my calendar of any outside work commitments I have and just taking time to do things I enjoy (finding a nice seat in a coffee shop and reading). I’m quite fortunate in that my brother is a doctor, so we can share our experiences with each other and understand where the other is coming from. Then, there is always the therapeutic natter with a well-trusted crew mate.

The stigma of mental-health problems is also a recognised barrier to those wanting to seek help. The perception that ambulance service staff are immune to difficult circumstances, that we come equipped with some sort of emotional force field, is a false mentality that is detrimental to those that need support. I remember as a student paramedic, starting my training with the thought that you shouldn’t be affected by things you see on the road, because to be a paramedic you need to be ‘tough enough’ to deal with them, and if you’re not then you are in the wrong job. I am grateful to the paramedic who showed me that this wasn’t the case, after a nasty traumatic cardiac arrest. He took us off road and made sure I was ok, explained the different means of support available and took the time to talk things through. I hope that I get this important message across when I work with students now.

So next time you’re speaking to a paramedic, emergency service staff or volunteer, do ask them about their job, because most of them absolutely LOVE to talk about their jobs and share all of the bizarre and crazy things we get up to (ahem, whilst remaining confidential and respectful), just maybe don’t ask them “What’s the WORST thing you’ve EVER seen?”.

You can check out the Blue Light Programme by clicking on the link below, following them on twitter @mindbluelight and using the hashtag #mybluelight.



Here is a link to another blog by a paramedic talking about mental health, featured in the metro.

Reference list (Thanks to Emma Vyvyan (@mrsevyvyan) for pointing me in the right direction to find the literature)

  • Bentley, M. MacCrawford, J. Wilkins, J. Fernandez, A. & Studnek, J. (2013). An assessment of Depression, Anxiety and Stress among Nationally Certified EMS professionals. Prehospital Emergency Care, (17), 330-338.
  • Regehr, C. Goldberg, G. & Hughes, J. (2002). Exposure to Human Tragedy, Empathy, and Trauma in Ambulance Paramedics American Journal of Orthopsychiatry. Educational Publishing Foundation 72(4), 505–513.
  • Bennett, P. Williams, Y. Page, N. & Woollard, M. (2004). Levels of mental health problems among UK emergency ambulance workers. Emergency Medical Journal, (21), 235-236.
  • Bennett, P. Williams, Y. Page, N. Hood, K. & Woollard, M. Vetter, N. (2005). Associations between organizational and incident factors and emotional distress in emergency personnel. British Journal of Clinical Psychology, (44), 215-226.
  • Donnelly, E. (2011). Work-related stress and posttraumatic stress in emergency medical services. Prehospital Emergency Care16(1), 76-85.

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