Understanding prehospital provider experiences of moral distress

Jelena Durdic, MS – University of Colorado; Gianna Morales, MH – University of Colorado; Chelsey Patten, DBe, HEC-C – University of Colorado

Abstract: Emergency medical service (EMS) providers, including emergency medical technicians (EMTs) and paramedics, deliver critical care in high-stress environments. While their exposure to occupational hazards and associated health consequences are well documented, moral distress remains understudied in this population compared to nurses, physicians, and veterans.

EMS providers work in unpredictable settings where moral distress may arise from difficult patient care decisions, such as determining termination of resuscitation or treating pediatric patients when parental decisions conflict with provider judgment. Structural challenges like staffing shortages and mandatory overtime, along with systemic limitations, like transporting non-emergent patients who misuse 911, further contribute to distress.

Research on moral distress in EMS is limited, with most studies conducted outside the U.S. Existing evidence suggests high prevalence and studies in other countries highlight the psychological toll, including diminished self-worth, anger, hopelessness, and self-destructive coping mechanisms. EMS providers are at high risk for adverse outcomes like PTSD and burnout and moral distress may exacerbate ongoing mental health and retention challenges. Despite these risks, little is known about how U.S. EMS providers experience or mitigate moral distress.

We will explore the moral stressors unique to this understudied population and present preliminary data from an interview and focus group study with licensed EMS providers in a major metro area. We will discuss: (1) causes of moral distress, (2) experiences and coping mechanisms and (3) desired interventions and supports. Our presentation will enhance understanding of moral distress in prehospital care and identify opportunities for intervention.

Keywords: moral distress, emergency medical services, prehospital care