Words By Simon Sawer
Recently we published the result of a systematic review of the literature on the incidence, prevalence and trends in health outcomes for paramedics working in Australia and New Zealand. We reported on every health outcome we could find in the literature, while attempting to limit this study to paramedics working primarily with state-based public ambulance services.
We reported on three key outcomes:
- Prevalence – or the proportion of paramedics who meet criteria for the health outcome during the period of study (a useful as a measure of how many paramedics are diagnosable with the health outcome at any given time)
- Incidence – or the proportion of paramedics who developed the condition during the period of study (useful as a measure of how many paramedics are expected to experience the health outcome), and
- A best estimate of the prevalence or incidence for each health outcome – which we generated from the results of the available studies, using both the recency of the data as well as the methodological quality of their study as key determinants
When publishing research you mostly want other researchers to read your work, but in this case I want other Paramedics to read and understand the implications of this piece of work. Therefore, this explainer isn’t aimed at researchers, it’s is aimed at Paramedics. While the study was aimed specifically at paramedics from Australia and New Zealand, the data is relevant to Paramedics worldwide, and in this I’m including PTOs, EMTs, ESOs, Paramedics, Intensive and Flight Paramedics, and Community and Extended Care Paramedics. All of us.
There was a lot of data that had to be sifted through, categorised, and evaluated. I learned a great deal, not just from the outcomes we generated, but also from the process itself. So, here are:
6 key lessons I learned from studying the health of Australian and New Zealand Paramedics:
1. Our health is bad
For anyone who hasn’t looked at our article, here are some stats for you:
- Over half of us are overweight or obese (57.3%)
- 4 out of 5 of us have poor sleep (80.6%), and over half are fatigued (55.6%)
- 2 out of 5 are at high risk for Obstructive Sleep Apnoea (41.5%)
- Between a third and a half of us are totally burnt out (33.3% - 56.4% depending on the measure used)
- 16% of us have a current diagnosis of depression (and around a quarter can expect to be depressed at some point in or after their career [26.5%])
- 13.8% of us have a current diagnosis of anxiety (and 21.0% can expect to be diagnosed)
- About a third of us have High – Very High distress (29.0%)
- 8.9% of us have a current diagnosis of PTSD (and 12.4% can expect it at some point)
- 26 paramedics for every 100,000 will complete suicide (which is 2.6 times the Australian National average)
- 5 paramedics for every 100,000 will die from drug-related incidents, and 9 will have a workplace fatality (mostly MVA related)
- 141 paramedics for every 1,000 will have a workplace injury
And let’s not forget, all these figures are expected to be underestimated.
We are in the highest band for almost all these health outcomes when compared with the general public, and most other occupations, including other healthcare services and other emergency services.
As a disclaimer here, I will note that we mention in our review that the methodological quality of the studies we included was often classified as low. The data was also often quite old. This means we can’t rely on the data to be a true reflection of the current state of paramedic health, but it is the best publicly available research data we have to rely on at the moment.
2. We really don’t know a lot or anything at all about several health outcomes
We listed all the quantifiable health outcomes we could find in the data. Admittedly we may have missed some research, but we have no idea about health outcomes I’d expect to be a problem for paramedics, such as cardiovascular health, cancer, reproductive outcomes, and relationship wellbeing (which includes witnessing, experiencing, and perpetrating family violence).
This is a huge gap in the literature.
3. We really don’t have much trend data, so we don’t know if things are getting better or worse for a lot of health outcomes
The only reliable trend data we could identify was related to workplace injury. For all the other health outcomes there was either only a single data point, or repeated measures weren’t reliably comparable. Add to this that now covid has come and made everything harder, we can expect things have probably gotten a lot worse.
Incidentally, while workplace injury is trending down, the driver behind this is almost entirely upper body musculoskeletal. Other workplace injuries either aren’t changing, or they are actually increasing, such as with mental health claims.
4. We really don’t know much at all about the interaction between different health outcomes
Very few of the studies looked at the interplay between health outcomes. There were some examples of studies looking at multiple health outcomes, such as Beyond Blue’s National study on emergency service workers, and a great study by Khan et al [which you should read, linked here ]. But primarily we are only studying health outcomes in isolation, which is understandable from a research perspective, but not ideal from a ‘that’s not really how health and wellbeing works’ perspective.
5. We aren’t doing enough to study the association between health and wellbeing and human factors
In the included studies, reporting on health outcomes by gender, sexuality, work location, and First Nations status or ethnicity was rare. This is important to study, as we know that gender and sexuality play a role in BMI, burnout, and suicidality, and that location of work seems to be related to suicidality. We also know that’s women’s health is understudied. First Nations status was not considered in any of the studies included in this review, so we really know nothing about the impact or experience of the role for Paramedics identifying as First Nations or Indigenous.
6. We really don’t know what is driving the health outcomes (but I do have a strong suspicion)
From the available data in our study, it’s not really possible to determine what is driving the health outcomes. This was out of scope for our research, but nonetheless it’s worth noting that the studies we have included mostly don’t provide any reliable insight into why the health outcomes are occurring.
It’s quite difficult to study this in general, but there is mounting evidence that workplace factors are a key driver. By this we mean it’s not just what we see, hear, smell, touch and do, but the conditions we work under and the employment practices of ambulance services
What should we do with all this information?
This is our data, and this is our health and wellbeing. We as Paramedics need to own this data, and we need to own the response. We shouldn’t wait for ambulance services to recognise this problem and take action, we should take charge and we should drive the necessary research and changes so that we can be healthy and happy in our profession.
As I’ve just pointed out, we have a lot of gaps in what we do and don’t know. So, what do we need to answer these questions? A National, longitudinal study would be a really good start, and would allow us to put the most effort into the areas needing rapid changes.
Such a study needs to look at key research questions like:
- What is driving poor paramedic health? And when does it start? Is it the nature of the work, employment conditions or organisational policies? Or is it something to do with the kind of people who are attracted to a career as a Paramedic?
- What is the full spectrum of Paramedic health outcomes we need to be concerned with? We know enough to say that mental health and suicidality is a huge problem, but what about cancer? What about reproductive outcomes? What about cardiovascular health? What about relationship health? We really don’t know much at all about these kinds of health outcomes.
- What human factors are associated with health outcomes, and what can we do to ensure the health and wellbeing of all Paramedics is considered, with respect to individual needs and experiences.
- How do the different health outcomes interplay and associate with one another? For example there appears to be a link between fatigue and mental health in paramedics, and there is good supporting literature to demonstrate the associations. But what we can’t say for sure is in which direction the association occurs for Paramedics. Do we start out fatigued, and then become more susceptible to mental health outcomes, or does it work the other way around?
Data from such a study will help us identify which priority areas of health need actioning now, and can provide useful baseline data to measure the impact and effectiveness of interventions aimed at improving health.
What I think is most important is that we need to take charge of our own health and wellbeing. We can start this process by taking control of our data, and pushing for a National, longitudinal study on health. And we can use this data to drive change, to ensure that Paramedics (and their families and friends) aren’t the ones expected bear the burden of this career on their health.