By Matthew Hill

Lecturer in Paramedicine, University of the Sunshine Coast, PhD Candidate, Central Queensland University, Member, Australasian College of Paramedicine Wellbeing Working Group

"A key concern is the degree to which family and friends may experience secondary traumatic stress symptoms"

It is no secret that paramedic work is stressful and much of the literature to date has, appropriately, focused on examining the mental health and wellbeing of paramedics and other first responders so they can continue to carry out their daily work (Mackinnon et al., 2020).

Exposure to physical violence, fatal accidents, and events involving the death, injury and the suffering of others are all examples of the types of potentially traumatic events (PTEs) that paramedics regularly face (Lee et al., 2020).

Given the nature of these events, paramedics are at risk of developing post-traumatic stress disorder (PTSD) and other trauma-related mental health conditions (Heber et al., 2023). In fact, paramedics have been reported to have higher rates of probable PTSD compared to the general population (Hoell et al., 2023), while the prevalence rates for anxiety, depression and general psychological distress among paramedics have been reported to be 15%, 15%, and 27% respectively (Petrie et al., 2018). This highlights the substantial impact that this line of work can have on paramedics and is likely why many organisations who employ paramedics now have established employee assistance programs (EAPs) dedicated to supporting the mental health and wellbeing of paramedics and their families. However, not all paramedics are comfortable accessing the support available to them through their EAP.

There are several barriers that may prevent paramedics from accessing the organisational support services available to them, including stigma and poor workplace culture (Coyte et al., 2024; Mackinnon et al., 2020). These barriers may partly explain why paramedics generally prefer to seek support from a close family member or friend to cope with the demands of their work (Donnelly et al., 2016).

Family members and close friends play a pivotal role in supporting paramedics to cope with their stress. The support families provide paramedics is broad and may include emotional, practical, psychological and financial support (Fitzpatrick et al., 2024). However, the provision of this support can take its toll on the mental health of those who provide it (Fitzpatrick et al., 2024). In addition to the challenges of dealing with their paramedic’s mental health concerns, family and friends may face additional challenges, such as limited time to provide support, exhaustion, burnout, and uncertainty around what to say and do, all while feeling unsupported in their role as a carer (Fitzpatrick et al., 2024). However, a key concern is the degree to which family and friends may experience secondary traumatic stress symptoms due to hearing about their paramedic’s traumatic experiences.

While speaking to a close family member or friend is likely a key coping strategy for many paramedics, there is a risk that these loved ones may experience symptoms of secondary traumatic stress due to hearing about their paramedic’s traumatic experiences (Figley, 1995). This means that family members and friends who support paramedics may experience symptoms that are identical to the symptoms of PTSD (e.g., intrusive recollections, hyperarousal, and avoidance of traumatic event reminders) after hearing about their paramedic’s experiences (Bride & Figley, 2009; Figley, 1995).

My research team’s recent review examined evidence relating to secondary traumatic stress among partners of paramedics (Hill et al., 2024). While there were few studies that had specifically investigated secondary traumatic stress among the partners of paramedics, it found that (1) partners of paramedics are aware of, and affected by, their paramedic’s post-traumatic stress symptoms; (2) post-traumatic stress symptoms experienced by paramedics can have a widespread impact on couple functioning; and (3) partners of paramedics understand the need for healthy coping strategies; however, perceive that little support is available to them (Hill et al., 2024). While the findings of this research help to validate the theory that those who support paramedics can themselves become traumatised, it also presents the broader paramedicine community with an opportunity to improve the support provided to those family members and friends who support our paramedics.

There is clear evidence that family support is a key resource for many paramedics and that the absence or depletion of this resource can have a negative impact on how well paramedics cope with their work-related stress. A study by Meacham et al., (2025) highlighted the important role that family support plays in buffering against the negative effects that role overload has on resilience, and subsequently the paramedic’s intention to leave their job.

This study highlights how resources outside of the organisation can benefit those paramedics working for the organisation and the organisation themselves. Therefore, organisations and clinicians responsible for supporting the mental health and wellbeing of paramedics should consider the impact that providing informal support can have on close family members and friends, including the impact that this can have on their relationship with the paramedic (Fitzpatrick et al., 2024; Henry et al., 2024).

Many organisations do have EAPs that extend their services to family members and have established policies that focus on family-friendly practices. Continuing to develop these programs and policies will be of benefit to paramedics, their families, and their organisations (Meacham et al., 2025). However, we also need to ensure that access to this support is being promoted to paramedics and their families to ensure that everyone is aware of the support that is available to them (Henry et al., 2024).

Finally, providing opportunities for family members and friends to engage in education about the mental health implications of paramedic work, including what signs to look for that might suggest their paramedic is not coping and how to manage their paramedic’s mental health concerns, would be beneficial (Fitzpatrick et al., 2024).

Exposure to potentially traumatic events in paramedicine is unavoidable. Alongside the support provided through EAPs, close family and friends of paramedics play a key role in supporting paramedics to cope with the stressors they experience due to their work. However, providing this support can have a real impact on the mental health those family members.

Fortunately, by harnessing existing supports and proactively educating the paramedic workforce and their families, there is real potential to reduce the burden on those family members and friends who provide support to paramedics. Ultimately, this will lighten the load of stress for both paramedics and those who provide them with support. This in turn may help reduce paramedic burnout and post-traumatic stress.

References

Bride, B. E., & Figley, C. R. (2009). Secondary Trauma and Military Veteran Caregivers. Smith College Studies in Social Work, 79(3-4), 314-329. https://doi.org/10.1080/00377310903130357

Coyte, B., Betihavas, V., Devenish, S., & Foster, K. (2024). Resilience, posttraumatic growth and psychological wellbeing of paramedicine clinicians: An integrative review. Paramedicine, 21(1), 16-35. https://doi.org/https://doi.org/10.1177/27536386231206501

Donnelly, E. A., Bradford, P., Davis, M., Hedges, C., & Klingel, M. (2016). Predictors of posttraumatic stress and preferred sources of social support among Canadian paramedics. CJEM, 18(3), 205-212. https://doi.org/10.1017/cem.2015.92

Figley, C. R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. Routledge.

Fitzpatrick, S., Mitchell, C., Bell, L., Cuenca, J., Ditton-Phare, P., Vallender, K., & Fitzgeraldson, E. (2024). Mixed-Methods Consultation Study of Family and Friends Supporting a Paramedic Experiencing Mental Ill-Health or Suicidal Distress. Illness, Crisis & Loss, 10541373241267970. https://doi.org/10.1177/10541373241267970

Heber, A., Testa, V., Groll, D., Ritchie, K., Tam-Seto, L., Mulligan, A., Sullo, E., Schick, A., Bose, E., Jabbari, Y., Lopes, J., & Carleton, R. (2023). Glossary of terms: A shared understanding of the common terms used to describe psychological trauma, version 3.0. 43(10/11). https://doi.org/10.24095/hpcdp.43.10/11.09

Henry, M. C., Burks, M. A., & Zoernig, E. L. (2024). PTSD, Relationship Satisfaction, and Social Support for EMS Workers and Their Romantic Partners. The Family Journal, 32(1), 102-111. https://doi.org/10.1177/10664807231198866

Hill, M. A., Paterson, J. L., & Rebar, A. L. (2024). Secondary traumatic stress in partners of paramedics: A scoping review. Australas Emerg Care, 27(1), 1-8. https://doi.org/10.1016/j.auec.2023.06.002

Hoell, A., Kourmpeli, E., & Dressing, H. (2023). Work-related posttraumatic stress disorder in paramedics in comparison to data from the general population of working age. A systematic review and meta-analysis. Front Public Health, 11, 1151248. https://doi.org/10.3389/fpubh.2023.1151248

Lee, W., Lee, Y.-R., Yoon, J.-H., Lee, H.-J., & Kang, M.-Y. (2020). Occupational post-traumatic stress disorder: an updated systematic review. BMC Public Health, 20(1), 1-12. https://doi.org/10.1186/s12889-020-08903-2

Mackinnon, K., Everett, T., Holmes, L., Smith, E., & Mills, B. (2020). Risk of psychological distress, pervasiveness of stigma and utilisation of support services: Exploring paramedic perceptions. Australasian Journal of Paramedicine, 17, 1-7. https://doi.org/https://doi.org/10.33151/ajp.17.764

Meacham, H., Holland, P., Pariona-Cabrera, P., Kang, H., Tham, T. L., Bartram, T., & Cavanagh, J. (2025). The role of family support on the effects of paramedic role overload on resilience, intention to leave and promotive voice. Personnel Review, 54(1), 236-255. https://doi.org/10.1108/PR-08-2023-0685

Petrie, K., Milligan-Saville, J., Gayed, A., Deady, M., Phelps, A., Dell, L., Forbes, D., Bryant, R. A., Calvo, R. A., Glozier, N., & Harvey, S. B. (2018). Prevalence of PTSD and common mental disorders amongst ambulance personnel: a systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology, 53(9), 897-909. https://doi.org/10.1007/s00127-018-1539-5