Are Paramedicine Students Experiencing Post-Traumatic Stress as a Result of a Clinical Rotation?

THE PSYCHOLOGICAL TOLL OF CRITICAL INCIDENTS IN EMS WORK

Critical incidents in EMS work—events involving death, serious injury, or emergencies—can result in PTSD or other stress-related reactions among paramedics. Alexander and Kleinfound that such high-stakes situations compromise the mental health of first responders.²⁸

Cumulative trauma exposure may lead to PTSD, depression, and even suicidal ideation among EMS professionals, demonstrating the need for support mechanisms.^18,22 Moreover, factors such as working conditions, high workload and time pressures contribute to stress, compounding the psychological impact of traumatic experiences.²⁹

PARAMEDIC STUDENT EXPOSURE TO TRAUMA

For paramedic students, exposure to trauma during clinical rotations introduces unique mental health risks. While they’re essential for developing competence, these experiences may elicit post-traumatic stress symptomology, particularly if students lack effective coping strategies or social support.

The research indicates that paramedic students and other healthcare students face elevated PTSD risks due to inexperience and the demanding nature of the work.^10,8 Further studies suggest that the emotional toll of witnessing or participating in critical events during training is substantial, requiring institutional support to prevent adverse psychological outcomes.^30,31

MECHANISMS OF POST-TRAUMATIC STRESS IN PARAMEDIC STUDENTS

The research identified several contributing factors to PTSD in paramedic students. Exposure to severe injuries, involvement in critical incidents, inadequate coping mechanisms and childhood trauma all increase susceptibility to PTSD.³²

Frequent exposure to high-stress environments and traumatic scenes, compounded by the nature of emergency work, exacerbates stress and heightens PTSD risks.^33,34 Among students, personal involvement in emergencies without adequate support amplifies feelings of vulnerability and emotional distress.³⁵

COPING MECHANISMS AND RESILIENCE

Resilience, defined as the ability to adapt positively to adversity, is essential for paramedic students coping with traumatic exposure. Studies show that resilience can significantly reduce PTSD symptoms and improve overall well-being.³⁶

Social support networks, such as peer discussions and mentorship, serve as critical buffers against stress by providing emotional guidance.³⁷ Effective coping strategies, including debriefing and structured support interventions, are integral to managing stress and fostering resilience.³¹

PREDICTORS OF PTSD AND IMPACT OF CHILDHOOD TRAUMA

Research highlights adverse childhood experiences (ACEs) as significant predictors of PTSD in paramedics. ACEs, including abuse or neglect, increase vulnerability to PTSD by affecting emotional regulation and mental resilience.³⁸

Childhood trauma may disrupt attachment and coping mechanisms, further impacting paramedics’ ability to manage occupational stressors effectively.^39,40 Paramedic students with high ACE scores are particularly susceptible to mental health challenges, emphasizing the need for targeted support in educational programs.

EXISTING LITERATURE ON COPING AND SUPPORT INTERVENTIONS

Social support, specifically from family and peers, positively impacts coping and reduces PTSD risk by enhancing emotional resilience.⁴¹ A study by Lowery and Stokes showed that emergency healthcare workers with strong social support networks reported lower levels of perceived stress, indicating the protective effects of social bonds in high-risk professions.⁴²

Furthermore, resilience-building measures, such as resilience training, peer support and structured debriefing, are essential for paramedic students to manage trauma exposure healthily.⁴³

SIMULATION AND TRAUMA-INFORMED EDUCATION IN PARAMEDIC TRAINING

Incorporating simulation-based training into paramedic education offers significant benefits by replicating real-life scenarios in a controlled environment. Simulation training enhances critical thinking and decision-making skills while allowing students to learn from mistakes without immediate real-world consequences.⁴⁴

Additionally, trauma-informed approaches in paramedic education, which emphasize understanding and empathy toward trauma survivors, help students prepare for high-stress situations and foster psychological resilience.⁴⁵

The literature underscores the need for comprehensive support systems within paramedic education to address students’ mental health needs effectively. Repeated exposure to critical incidents during training can lead to lasting psychological effects, including PTSD, making it essential for paramedic programs to incorporate resilience-building and trauma-informed practices.

Enhancing coping mechanisms through social support, mentorship, debriefing and simulation-based education can mitigate stress and foster resilience, ultimately promoting better mental health outcomes for paramedic students.

THE RESEARCH STUDY

The study explored critical incident exposure during paramedic training, and the development of post-traumatic stress symptoms. By examining these variables, this research provides insights into the factors contributing to PTSD in paramedic students and identifies coping strategies to mitigate the adverse effects of trauma exposure.

The study addressed the following question. What is the impact of critical incident exposures during paramedic education on the development of post-traumatic stress symptomology in students?

The primary aim of the study is to integrate findings into trauma-informed education that includes post-traumatic stress symptomology, coping mechanisms and accessible mental health resources. The goal is to foster a supportive environment for paramedic students, equipping them to handle critical incident exposure during training and throughout their careers.

The National EMS Advisory Council recommended updating the EMS Agenda for the Future, resulting in the EMS Agenda 2050, which emphasizes EMS practitioner wellness, resilience and stress management.

These guidelines underscore the need for mental health resources across all EMS training levels, aiming to mitigate high suicide rates and mental health struggles among paramedics National EMS Education Standards.⁴⁶

The standards now require comprehensive knowledge of PTSD and suicide prevention across EMS roles, promoting mental health as a core element in paramedic education National EMS Education Standards.⁴⁶

THE RESEARCH METHODOLOGY

This research study employed qualitative methodology; data were collected through open-ended survey questions. The purpose was to investigate exposure to critical incidents during paramedic education, and the development of PTSD symptoms in paramedic students.

This approach enabled a nuanced understanding of how professional experiences collectively contribute to students’ mental health outcomes.

Participants and Setting

The study included 81 paramedic students. A purposive sampling strategy was used, with inclusion criteria focusing on paramedic students in the United States who had completed at least one clinical rotation and were at least 19 years old.

Participation was voluntary and anonymous, ensuring that participants could share their experiences candidly. The survey was conducted via the secure Qualtrics platform, which preserved anonymity and privacy. Qualtrics also facilitated data collection and ensured no IP addresses were recorded, further protecting participant confidentiality.

Participants responded to open-ended questions about their clinical experiences, particularly focusing on exposure to critical incidents.

The anonymous nature of the survey encouraged participants to share freely, yielding valuable insights for understanding the impact of traumatic experiences on their mental health.

Data Collection Tools

The survey incorporated qualitative measures:

1. Qualitative Open-Ended Questions: These questions allowed participants to describe stressful or disturbing experiences during clinical rotations, any resulting symptoms and coping mechanisms. Sample questions included:
   • Have you had a stressful or disturbing experience during a clinical rotation?
   • Can you describe the experience and what made it stressful or disturbing?
   • How did you cope with the feelings associated with this experience?

The survey took approximately 20-30 minutes to complete, balancing depth of response with participant time constraints.

Data Collection Procedures

After obtaining Institutional Review Board (IRB) approval from Creighton University, the survey link was distributed through paramedic program directors in multiple states, including, Texas, Oklahoma, Virginia, Pennsylvania and Iowa.

Program directors shared the survey link with students via email, ensuring an indirect distribution method to prevent coercion. Participants had the option to withdraw at any point. Their responses were submitted anonymously, with all identifying information removed to ensure confidentiality.

Data analysis followed a thematic approach for qualitative responses to survey questions. The analysis included sing manual coding, qualitative responses were reviewed to identify common themes related to trauma exposure, coping mechanisms and PTSD symptomology.

To ensure methodological integrity, this study adhered to Levitt’s⁴⁷ standards of fidelity to the subject matter and the utility of research contributions.

Results and Findings

Qualitative analysis revealed three core themes: Stressful Experiences, Symptoms Experienced and Coping Strategies. These themes underscore the complexities of paramedic education and the need for supportive interventions.^48,49

Theme 1: Stressful and Disturbing Experiences

Students frequently reported exposure to traumatic situations, such as dealing with high-stress emergencies and professional conflicts. This aligns with previous findings on the demanding nature of paramedicine, where students are often involved in life-or-death scenarios that impact emotional resilience.⁵⁰

• Traumatic Deaths: Students encountering traumatic deaths, such as responding to pediatric emergencies, faced lasting emotional impacts. This exposure illustrates the toll on students’ psychological well-being.⁵¹
• High-Stress Scenarios: Performing critical interventions in high-stakes situations was a common stressor, echoing existing literature on the intense demands of emergency medical training.⁵²

Theme 2: Symptoms Experienced

Students described symptoms including psychological distress, behavioral changes and disruption of daily functioning. This finding is consistent with previous studies linking traumatic exposure in medical education to mental health challenges.^53,54

• Psychological Distress: Symptoms such as depression and anxiety were prevalent, with many students reporting panic attacks as a reaction to clinical trauma.⁵⁵
• Behavioral Changes: Increased irritability and substance use were reported as maladaptive coping responses, emphasizing the need for healthier strategies.⁵⁶
• Disruption of Daily Life: Trauma-related symptoms disrupted students’ sleep and motivation, underscoring the long-term impact of clinical exposure on daily functioning.⁵⁷

Theme 3: Coping Strategies

Students adopted varied coping mechanisms, from seeking social support to engaging in self-care activities. These strategies are supported in the literature as essential for managing stress in medical education.^58,59

• Social Support: Engaging with friends, family and therapists was a primary coping strategy, illustrating the importance of interpersonal support in resilience.⁶⁰
• Physical Activities and Self-Care: Activities like exercise and relaxation helped students manage stress effectively, aligning with best practices in self-care for healthcare professionals.⁵⁶

FINDINGS

The high prevalence of post-traumatic stress symptoms signals a need for targeted interventions in paramedic education, including mental health resources and resilience training.^61,62

This study illuminated the multifaceted nature of paramedic education, where traumatic experiences, professional conflicts and life-and-death scenarios pose significant challenges to students’ mental health.

Educators should consider pre-rotation preparation sessions and mental health support to mitigate the impact of clinical trauma.⁶³ Proactive engagement with students can foster a supportive learning environment, reducing the incidence of post-traumatic stress symptoms.

TRAUMA-INFORMED AND SUPPORTIVE EDUCATIONAL INTERVENTIONS

Paramedicine faces a growing crisis of PTSD and related mental health challenges, highlighted by the rising incidence of first responder suicides.

Given the lack of emphasis on PTSD in paramedic training, particularly regarding students’ exposure to trauma, another focus of this research was to provide foundational data for intervention strategies that promote student resilience and a positive wellbeing.

To effectively prepare paramedic students for emotionally challenging scenarios, programs should adopt trauma-informed curricula focusing on mental health awareness and trauma response. This curriculum could incorporate training modules on trauma physiology and psychological responses to traumatic events.^64,65

• Simulation-Based Training: Engaging students in trauma-related simulations allows for practical exposure to high-stress situations within a controlled environment, helping students build resilience and clinical confidence.⁶⁶
• Case-Based Learning: Integrating real-life case studies enables students to recognize trauma triggers and develop targeted intervention strategies, which is especially useful in fostering emotional awareness and response capabilities.⁵¹

PEER-SUPPORT NETWORKS FOR STRESS MANAGEMENT

Establishing structured peer-support groups provides a platform for paramedic students to share experiences, offering mutual guidance and camaraderie.⁵⁸Programs could implement:

• Buddy Systems: Pairing less experienced students with mentors who have completed clinical rotations can foster a supportive and empathetic learning environment.⁶⁷
• Student Organizations and Peer-Support Events: Organizing workshops or group activities on stress management and resilience builds a sense of community among students and provides a foundation for ongoing peer support.⁵⁴

ACCESS TO MENTAL HEALTH RESOURCES

Paramedic training programs should ensure students have access to counseling services and other mental health resources, especially tailored to the trauma-informed needs of healthcare students.⁶⁰

• Counseling Services: Developing partnerships with mental health organizations can increase access to trauma-trained counselors. Offering both in-person and telehealth options improves accessibility and addresses scheduling limitations.⁵⁴
• Group Therapy: Facilitating group sessions focused on resilience-building and coping skills provides students with a supportive space to process their clinical experiences, reinforcing mental health awareness.⁶⁸

FACULTY TRAINING IN TRAUMA-INFORMED EDUCATION

Faculty members should receive training on trauma-informed teaching practices, equipping them to recognize and respond to signs of stress in students. This also includes learning empathetic communication techniques to support students effectively during times of distress.⁵²

• Awareness of Mental Health Resources: Faculty must be informed of available mental health services, equipping them to guide students to these resources when necessary.⁵⁸
• Self-Care for Faculty: Programs should offer faculty resources on managing secondary stress associated with supporting students in distress.⁵³

COPING STRATEGIES PROGRAMS

Implementing structured programs on coping strategies, including mindfulness, resilience training and stress management, equips paramedic students with tools for maintaining mental well-being.⁶⁹

Encouraging practices such as reflection and self-care allows students to process their experiences more effectively. A staged approach is proposed, considering factors such as institutional buy-in, training and continuous evaluation. Key stages include:

1. Needs Assessment: Assess specific student stressors and support needs to ensure targeted interventions.
2. Curriculum Development: Create modules on trauma-informed care and coping strategies, along with partnership building for mental health resources.
3. Pilot Programs and Evaluation: Start with a small-scale test to refine the program based on initial feedback.⁷⁰

CONCLUSION

The findings of this study illuminate the significant mental health challenges faced by paramedic students due to exposure to critical incidents during clinical rotations. The high prevalence of post-traumatic stress symptoms underscores the necessity for trauma-informed and supportive educational interventions.

Incorporating resilience training, peer-support networks and access to tailored mental health resources can foster a supportive learning environment that mitigates the psychological toll of trauma exposure.

Simulation-based training and case-based learning further equip students to handle high-stress scenarios with confidence and emotional awareness. Faculty training in empathetic communication and mental health support ensures that educators are prepared to guide students through distressing experiences.

By prioritizing mental health and resilience within paramedic education, programs can better prepare students for the emotional demands of their careers, promoting both their personal well-being and professional sustainability.

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