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Psychological vulnerability and suicidality within the ambulance service: a review

02 December 2023
Volume 15 · Issue 12


Paramedics must be physically and mentally robust to seamlessly adapt between emergencies and disasters. Developing evidence suggests that ambulance colleagues may be at higher risk of suicide; yet few studies explore causal factors and effective interventions. Mental distress, illness and associated physical symptoms of emotional injury, have long been the subject of global systematic review; however, an inadequate understanding of the cumulative anguish leading to suicidality remains. Research has shown that occupational and organisational burdens, such as shift work and extensive hours, have a significant detrimental impact upon staff welfare. Individual responses to the multifaceted work nature and subsequent influences on distress have been found to create a ‘perfect storm’ for emotional vulnerability. Inherent camaraderie and stoicism have prevented openness, and therefore stalled the improvement of psychiatric support systems. Suicidality discussions can be neglected, subsequent to mental health stigmatisms, and the absence of data reduces accurate findings, therefore underestimating the current concern. Ambulance trusts must develop policy and procedure to protect staff, lower the incidence of mental fatigue and reduce suicide. Having dedicated their lives to public safety, paramedics require robust programmes designed to protect their physical and mental welfare. These must be endorsed at the highest level, ensuring confidence and trust from the diverse workforce.

The role of the paramedic has gone through seismic change since its inception in the 1960s and is no longer limited to the management of advanced life support and disaster. Paramedics must now be confident and competent to manage and adapt to a multitude of presentations, especially as the service has become the most accessible form of healthcare in the UK (Eaton et al, 2018). With such diversity in types of demand and an increased dependence on the service, paramedics are now under more pressure than ever before (BBC News, 2019; Unison, 2022).

The current attrition rate of 10.3% annually, an increase of over 5% since 2011, and paramedic diversification into non-traditional working environments (Nuffield Trust, 2022) indicate that it is time to focus on the wellbeing of practitioners. This includes examining the potential for heightened stress and anxiety, which can, in some cases, lead to suicidal ideation and suicidality.

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