Development of Posttraumatic Stress Disorder in Urban Emergency Medical Service Workers

Michael Blumenfield, MD, Daniel W. Byrne, MS


Medscape Psychiatry & Mental Health eJournal. 1997;2(5) 

In This Article


The setting of this study provided a unique opportunity to study a large population of subjects regularly exposed to the traumatic events inherent in the work of an urban EMS worker.

Ongoing exposure to significant trauma is an important factor in developing PTSD. Only 2.5% of cadets, who by definition are new to the job, met the criteria for PTSD. In contrast, 10.5% of emergency medical technicians (EMTs) and 15% of the experienced paramedics had PTSD. A higher percentage of PTSD was found in those who had more years in the service and in those with advanced rank. This latter point suggests that not only is the amount of exposure an important factor, but so is the degree of responsibility of the worker.

These PTSD prevalence rates may have been higher if it were not for the assumed attrition rate by those who were most affected by posttraumatic symptoms. Attrition may also account for the decrease from 15.0% incidence of PTSD in those with 7 to 10 years of service to 11.7% in those who have more than 10 years of service in EMS. Although age would be expected to increase with experience and rank, multivariate analysis of the data showed that age was not a strong independent predictor of PTSD.

Several risk factors for PTSD, not directly related to the EMS, were identified. Surprisingly, having attended a rural high school was a risk factor for PTSD in EMS workers who were younger than 35 years. Perhaps some exposure to the everyday trauma of city life provides some immunization for future traumatic exposure as an EMS worker. By age 35, the rural high school graduate has apparently made up this difference through other life experience. Divorced EMS workers apparently have a greater vulnerability to developing PTSD than workers in other marital categories. However, it is possible that the presence of PTSD was, in fact, a contributing factor leading to the divorce.

Previous 911 ambulance experiences (which in the past have been more likely to take place in larger cities) and previous medical or emergency work experiences were shown to be significant risk factors for PTSD. These appear to be further examples of previous exposure to trauma, which may have decreased the threshold for the development of PTSD once EMS work was started. The role of previous experience in a military war zone was also demonstrated as an underlying factor for developing PTSD, although the initial P value for the univariate analysis was not less than 0.05.

A cumulative risk model can be constructed by combining the 5 pre-existing risk factors with the 5 NYC EMS work factors. This model demonstrates the statistical correlation of each factor having an additive effect in the development of PTSD. However, no data were given concerning previous psychiatric history in this population, which may have provided important correlations with PTSD. We believe that the information obtained from this study will be helpful to management and mental health professionals working with EMS personnel.


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