In March 2020, the World Health Organization (WHO) declared the outbreak of a new coronavirus disease,

Covid-19, a global pandemic.1 As countries, governmental agencies, and health authorities act to contain the

virus, this time of crisis is generating widespread psychological concerns. At particular psychological risk

during this pandemic are our healthcare professionals, including our paramedic practitioners. We are issuing

this position statement to highlight what the existing literature tells us about the mental health effects of

previous pandemics on frontline healthcare staff. It is also critical to acknowledge how Covid-19 has already,

at this relatively early stage, impacted the working environment for healthcare professionals, our members

included. And perhaps most importantly, we want to advocate for the psychological support of the



According to previous studies from SARS, H1N1, MERS, and Ebola epidemics, the psychological burden that

healthcare professionals experience during these crises is significant.2 Both their physical and mental wellbeing

has been shown to be compromised by a myriad of factors including increased workload, physical

exhaustion, insufficient personal protective equipment, and the potential distress of making ethically difficult

decisions regarding the rationing of care.3 Furthermore, the resiliency of these healthcare professionals can

be further compromised by isolation and loss of support, risk of or infections of family and friends, as well as

often unsettling changes in medical protocols and workplace procedures.3


Studies have indicated that healthcare professionals are vulnerable to specific mental health concerns both

during and after pandemics. In a study of 1800 hospital practitioners in Hong Kong after the 2015 MERS

outbreak, it was found that medical staff who performed MERS-related tasks showed the highest risk for

posttraumatic stress disorder symptoms.4 Surveys from over 10,000 healthcare workers in Singapore after

SARS found that staff in daily contact with SARS or staff from SARS-affected institutions expressed

significantly higher levels of an anxiety.5 In addition, more than half reported increased work stress and

workload. And here in Canada, the Impact of SARS Study found that one to two years after the outbreak,

professional burnout and symptoms of traumatic stress, anxiety, and depression remained elevated among

Toronto hospital workers compared with colleagues in settings that did not treat SARS patients.6

Research has already started to emerge regarding the psychological implications of Covid-19 on front-line

healthcare providers. Systematic reviews conducted of these studies indicated that healthcare workers are

encountering a considerable degree of stress, anxiety, depression, and insomnia.3,7 For example, a survey of

1257 healthcare workers in China found that a considerable portion reported symptoms of general distress

(71.5%), anxiety (44.6%), depression (50.4%), and insomnia (34%).8 Another observational study of 180

healthcare workers found substantial levels of anxiety and stress that negatively impacted sleep quality and

feelings of self-efficacy.9


Our position is that the Covid-19 pandemic will impact the psychological health of paramedics and

dispatchers. The workload and burden has already increased, as the BCEHS CISM team was activated on

232 occasions in April 2020 as opposed to 130 activations in April 2019.


It is imperative that we learn from previous pandemics and the aforementioned research. It should help us

predict future mental health needs, and act and prepare accordingly. We are also aware that in the absence

of a pandemic, our profession is already at higher risk for stress disorders than most other occupations.10

Therefore, we feel strongly that the profession should be psychologically supported both during this time and

on an ongoing basis. It is true that healthcare providers who feel well supported and trained experience better

mental health over the long term.11 Organizational provision of psychological services, support for staff in

isolation/quarantine, peer support, as well as communication, empowerment, and humanity from leaders

have been identified as considerations for supporting healthcare providers during this pandemic.12 We feel

strongly that paramedics and dispatchers deserve to have access to these kinds of supports for their mental



(Writing and recommendations by Dr. Kathy Keating, Registered Psychologist (CPBC #2169), Commissioned by the Ambulance

Paramedics & Emergency Dispatchers of BC)


Provincial Executive Board

Ambulance Paramedics & Emergency Dispatchers of BC

CUPE Local 873

Please click HERE to view Position Statement with footnotes.