Supporting First Responders: Mental Health and Resilience Among Rural Emergency Personnel

First responders’ mental health is disproportionately affected during and following an emergency or disaster. Those who work in the agricultural community experience unique stressors, including financial concerns, farm debt, and anxiety about the future of the industry.

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Training and Education

Rural communities rely on emergency medical services (EMS) providers to provide vital care in their time of need. These professionals often work alone or as part of a small team of first responders. They are responsible for performing complex transfers to the nearest hospital and may encounter situations that require immediate life-saving measures. The rural EMS workforce must be well trained to meet a wide spectrum of needs in sparsely populated areas.

The responsibilities of first responders in rural EMS settings can be physically, emotionally, and psychologically taxing. As a result, they are at a higher risk for experiencing symptoms of post-traumatic stress disorder (PTSD) and other mental health conditions. Many of these workers are volunteers who perform their duties despite the demands of their day-to-day lives. In fact, a survey found that among the factors that drive individuals to join local EMS, satisfaction in helping others was the most significant driver. In addition, respondents reported that community need, interest in EMS, and the challenge of their work motivated them to stay with their organization.

Providing the support necessary to maintain their mental health is important for the long-term effectiveness of rural first responders. A decline in morale can lead to costly consequences for the organization, including increased absences, staffing shortages, costs of benefits and insurance premiums, departmental overtime, and increased employee turnover. These factors can exacerbate existing financial issues in the region, making it difficult to continue to provide high quality emergency services.

In the United States, a number of medical schools are starting to incorporate interprofessional education (IPE) in their curriculums to help prepare future healthcare professionals for working in rural underserved areas. For example, some programs allow students to complete a clinical rotation at a rural hospital through the Teaching Health Center Graduate Medical Education (THCGME) model, which allows residents to gain experience with local medical professionals and learn how to collaborate with them in a team-based approach to patient care.

To ensure that healthcare professionals are prepared for the unique challenges of rural EMS, IPE programs should include elements that build cultural competency. This training will enable healthcare professionals to work effectively with patients who have backgrounds, beliefs, and language skills that are different from their own. To this end, the CDC recommends that IPE programs incorporate cultural humility, which involves an awareness and appreciation of differences between cultures. The Canadian government has also developed a program that provides rural firefighters, EMS workers, and law enforcement personnel with PTSD training and PTSI resources in both virtual and in-person formats, as well as through the downloadable Espri by TELUS Health app.

Communication and Coordination

During a mass-casualty event, communication among all first responders is vital. It is especially important for rural emergency departments, which can be a long distance from urban tertiary care facilities. The ability to effectively triage, stabilize, and transfer patients to these hospitals is life-saving.

To help facilitate communication, new technology and systems must be developed that are reliable in the face of disaster. For example, radio interoperability must be improved to enable all public-safety agencies, whether they are governmental or nongovernmental, to communicate with one another during an emergency, especially in the field.

Additionally, a system that allows hospital and healthcare facility command staff to communicate with EMS agency leadership needs to be implemented. This will enable the hospital to provide critical information on its capabilities, bed availability, and other relevant data to EMS leaders in the field. It will also make it easier to coordinate patient flow and ensure that patients are matched with appropriate hospital resources.

Emotional resilience is an individual’s capacity to deal with trauma and adversity, and cope with the stresses of daily life. This includes the ability to identify healthy coping mechanisms, such as bolstering social connections and engaging in self-care, and to tap into realistic optimism in the face of adversity. A recent survey conducted by Everyday Health found that people with higher levels of emotional resilience have a greater sense of overall well-being and life satisfaction.

The adversity that rural EMS personnel experience, both in the field and in their daily lives, can be overwhelming, even for those who are resilient. It is important that these workers be able to maintain their mental health and resilience by having access to training and support services. NAEMT, in partnership with FirstNet(r), Built with AT&T, has an EMS mental health and wellness initiative that offers courses on how to recognize signs of stress, depression, and suicide risk. These courses are delivered to EMS crews and their family members in the community.

The program also provides a course for EMS agency leaders to learn how to serve as their organization’s mental health resilience officer. The MHRO course trains these individuals to engage with peers to understand and address mental health issues, identify those in need of assistance, and navigate them to services that can help.

Lack of First Responders

Rural first responders have limited access to mental healthcare services. This is because many of these personnel are fearful of the stigma associated with seeking psychological care. Additionally, some first responders believe that they may lose their jobs if they seek mental healthcare assistance.

Despite this, there are efforts to increase awareness of mental health issues for first responders. However, there is a need for more resources that specifically focus on helping rural emergency workers.

For example, one of the most common reasons for CPR preparedness gaps between urban and rural communities is that there are few hospitals or healthcare providers that offer CPR training in rural areas. This leads to rural residents having difficulty learning how to perform life-saving techniques, and it also means that victims of cardiac arrest in rural areas often receive a slower response or do not receive any help at all, which can significantly impact their survival rates.

Resilience is the ability to adapt to stressful situations in a positive way. This includes a person’s ability to connect with others, as well as his or her ability to solve problems and maintain a sense of optimism. It is important for rural emergency workers to develop resilience, so that they can overcome the challenges they face when responding to calls.

To do this, they need to build their resilience through a variety of methods. For example, a person can practice stress regulation by learning to control his or her emotions and focusing on what is within his or her control. It is also important to have a strong support system. People who are resilient tend to have close friends and family members that they can count on during challenging times.

Rural emergency workers have unique needs that require special consideration. For example, they must learn to cope with the emotional impact of a call and the possibility that someone will die as a result of their efforts. They must also be able to access medical supplies, such as AEDs, that are often limited in rural communities. In addition, they must be able to deal with the stress of working in a rural community, which can cause them to feel overwhelmed at times.