EMS crews in Calgary say they are being pushed to their limits by an ambulance system that is overburdened and under-resourced.
An online survey distributed to members in August by the local chapter of the Health Sciences Association of Alberta, which represents paramedics, shows respondents are struggling with their work, life and mental health.
At the end of the survey, respondents were asked whether they were considering leaving their jobs — 55 per cent said yes. Those who said yes were then offered an open-response section as to why and it garnered 117 responses.
“This employer thinks of us as a number and has no care what happens to us, whether it be a pediatric code [baby in cardiac arrest] or a shooting or stabbing, they don’t care, they expect us to just get ready for the next call and it’s sad and it sucks that our employer continues to beat us down,” wrote one respondent.
“It’s destroying me as a person,” wrote another. “Don’t know who I am anymore.”
“Due to overtime, fatigue, burnout, I feel like I cannot give to my friends or family,” reads another response.
“I don’t sleep before work, I’m always anxious when previously [I was] never a nervous person. The job doesn’t care about my safety or well-being, and the longevity of being in a toxic career is short.”
“I am currently working on my exit strategy from EMS so I can recover my personality/compassion,” says another. “Become a human being again, and treat my family and my body the way they deserve to be treated.”
Just over 72 per cent of respondents to the survey said their mental health had interfered with their duties at work over the previous two weeks — 36.5 per cent “extremely often” or “very often.”
Red alerts in Calgary
The survey was sent by EMS employees to CBC News following a recent story highlighting the fact there were 116 days last year that had red alerts — meaning no transport ambulances were available in Calgary — some lasting seconds, other with alerts popping in and out almost continuously for an hour or more.
The HSAA and EMS employees said those findings indicated a system under considerable strain that is taking a toll on paramedics.
Also sent to CBC News were Alberta Health Services surveys on working conditions for EMS crews province-wide conducted in 2015 and 2018.
Those surveys appear to support the findings of the more informal HSAA questionnaire and showed declining satisfaction in all areas but one, including psychological support and organizational culture, between 2015 and 2018.
The only category that remained stable from survey to survey was in regard to recognition and rewards at work.
In the 2018 AHS survey, 48 per cent of respondents showed “significant” or “moderate” concerns when it came to psychological support within EMS. That was up from 41 per cent in 2015.
When asked about a work environment “characterized by trust, honesty and fairness,” 69 per cent of respondents had “significant” or “moderate” concerns in 2018.
‘There’s no policies’
One paramedic familiar with the surveys, whom CBC News has agreed not to identify because they could lose their job or licence to practise, said they’re not surprised to see crews struggling with their mental health.
After traumatic calls, they said, there is no requirement to check on the EMS crew, to make sure they’re OK, or to give them some downtime before heading out to the next call.
“Most calls where they want to be out of service, there’s no push from the supervisors to go check on their crews. There’s no policies. There’s no direction for them to do this. Anything,” they said.
EMS employees who have spoken with CBC News by phone and by email over the past week have catalogued a list of grievances with the current system, all pointing to long hours of endless calls with almost no chance for breaks, deferred vacations and time off and little support.
Alberta Health Services, however, disagrees with that characterization.
It did not provide anyone for an interview, but sent answers by email.
“There are numerous resources within AHS broadly, and more specific to EMS, to protect the mental health of EMS paramedics and staff,” wrote spokesperson Erin Lawrence.
She outlined numerous initiatives, including two staff psychologists on staff in Alberta, a support dog team and a program for reintegrating staff when they return from a psychological injury.
“No employee is ever pressured to return to work. The health and safety of our paramedics is priority, and we would never do anything to jeopardize that,” said Lawrence.
“Following any difficult call, supervisors will talk to an employee, discuss how they are feeling and how they have been personally impacted by the call, and will ask if they need some downtime.”
In the HSAA survey, 52.7 per cent of respondents said they had not been offered supports or time out of service after a traumatic call. Another 28 per cent said any supports offered either were “not so helpful” or “not at all helpful.”
The EMS employee who spoke with CBC News said mental health became a big concern for the union in the aftermath of the mass killings in Brentwood in 2014, when five people were stabbed to death.
“Those people [who responded] never got an ounce of f–king prevention, debriefing, anything,” they said.
Asking for more to be done
Following that mass killing and the effects it had on EMS crews, the union sent an escalation letter to AHS demanding more work on protecting the mental health of paramedics.
The letter, sent to the AHS vice-president of workplace health and safety at the time and obtained by CBC News, said it had tried to work with the service to address concerns over post-traumatic stress and psychological safety for EMS.
“Our efforts thus far have been unsuccessful and the employer’s response to address this known hazard of this industry have been inadequate,” it reads.
That letter called for improvements to and monitoring of the existing Critical Incident Stress Management (CISM) program, a training tool for staff and supervisors regarding psychological hazards at work and how to respond, assessment surveys and the creation of a joint committee focused on workplace health and safety.
Of those, the training tool, the assessment surveys and the committee were created. The EMS employee who spoke to CBC News said CISM — which is meant to check on crews after a traumatic call — remains ineffective and the joint committee no longer meets.
Lawrence, with AHS, said there is a committee meeting scheduled in the “coming weeks” and the committee is still active, although “some of this work was paused due to the COVID-19 pandemic response.”
Lawrence said in addition to the progress listed from the letter, the committee has been responsible for creating the support dog program, instituting the surveys that were conducted in 2015 and 2018, bringing in grief and resilience training, a “connection to the existing spiritual wellness advisor network” and a change in curriculum for would-be paramedics related to mental health preparation.
CISM, the paramedic said, requires the affected crew to ask for help, and that was confirmed by AHS. The organization said that after a traumatic event, there are one-on-one check-ins with those involved through a peer support network.
It cited the recent rollover of a glacier tour bus in Jasper National Park as one incident where that process started but has yet to respond to a question about the threshold for that sort of intervention given the responses in the HSAA survey.
“So time out of service is something that came out of that mental health committee,” said the EMS employee.
“We said hey, if you do a pediatric code, or you know, multiple fatality call, certain calls should trigger you’re instantly out of service. Get yourself a coffee, let’s talk to you and make sure you’re OK before we send you out there. These guys have refused to bring that initiative forward. And there’s nothing formal in place. So when those guys say ‘I didn’t get offered help,’ they didn’t get offered.”
That employee said there has to be more work done prior to someone suffering a psychological injury on the job, rather than simply trying to reintegrate them back into their jobs after the fact.
AHS said it did not have any data to show whether leave of absence for dealing with mental health issues has increased or decreased year over year.