Australian paramedics under mounting pressure

Paramedics are in a frontline profession subject to the danger of coronavirus infection, with at least coronavirus 42 of them contracting the virus during Victoria’s recent “second wave.” Even before the pandemic, however, paramedicine was recognised as one of the most dangerous jobs in Australia.

According to Safer Work Australia, the government body responsible for workplace health and safety and compensation, paramedics had the highest rate of injury of any occupation prior to the COVID-19 crisis.

Consequently, these workers are subject to extremely high stress levels, and many face serious physical and mental health issues.

One 2020 academic paper from South Australia’s Flinders University examined the mental health and wellbeing of paramedics compared with other professions. It discovered they have far higher rates of mental health disorders, workplace violence and injuries, fatigue, sleep disorders and suicidal ideation than other jobs.

The study outlined patterns of frustration, helplessness, trepidation and feelings of being overwhelmed, leading to compassion fatigue and self-blame. Shift work reduced the time for recovery and had a negative impact on family roles, disrupting the structure of home life. Most paramedics work a mixture of day and night shifts, which is known to be one of the most damaging work patterns.

The paper described the workplace as resembling a “big brother” environment, in which relations with management were increasingly strained.

On-road staff felt that managers failed to understand, appreciate or respond to the distress of critical incidents.

Particular case types, such as the death of a baby or child, could contribute to significant distress. The strategy to cope was often to “compartmentalise” the event and associated emotions.

Given the workload pressures and performance indicators governing their jobs, the paramedics often had no time to deal with the effects of critical events.

The report explained: “In Australia, historically, these services had their origins in paramilitary culture, with a strong hierarchical chain of command, which in turn prizes stoicism in the face of adversity and compliance, with little sense of worker control or clinical autonomy, but also a high level of teamwork, camaraderie and public service.”

International studies also identified the adverse psychological, physical and social effects that can ensue for ambulance personnel. An English study has shown that a “mixture of high intensity and mundane work often created a difficult shift for paramedics’ mindset, with little respite or time for debriefing and dealing with administrative requirements during periods of intense emotions.”

That is, it can be extremely stressful to alternate a period of high intensity work such as dealing with injured or dangerously ill patients, and then to have to turn to operational and bureaucratic work requirements, with little time in between.

Often the culture of metrics (key performance indicators used by managers) meant that on-road staff become more concerned about the speed in which a job was performed, than caring for the patient.

Recently the issue of workplace culture came to the fore in Ambulance Victoria. Rasa Piggott is an advanced life support paramedic who wrote an open letter to Ambulance Victoria’s board chair Ken Lay alleging “active discrimination and instances of abuse in our workplace” and “horrible instances of sexual misconduct.”

Piggott called for an independent review and cited instances of “managers advising staff not to get pregnant if wanting to pursue a higher role, stating that they will not be considered for promotion if they plan on becoming pregnant and attempting to demote a person to a junior role for taking parental leave.”

Many paramedics have reported that most male paramedics supported gender equality, but a “boys club” culture was entrenched in some long-standing pockets of management.

Complaints cited by the Victorian Ambulance Union also related to the ‘culture” fostered by Ambulance Victoria and “the feeling that current or prospective MICA [intensive care] paramedics cannot voice their concerns due to fear of vilification, victimisation or other differential treatment.”

Ambulance Victoria had to resort to engaging the Equal Opportunity and Human Rights Commission to investigate the allegations of bullying.

Management treatment of staff also came under fire on social media. One female paramedic wrote on Facebook: “You are my hero Rasa. Well done, young lady. I’ve put up with this for over 20 years. I love what I do. I’m proud to be a paramedic. But it has been the most stressful career I’ve ever had. Not due to the work, but dealing with management.”

These allegations highlight the range of problems faced by paramedics.

The issue of shift work was the subject of a 2018 national study, which found that of 18,600 employees, 57.8 were doing rotating shift work, 20.2 percent had a regular daytime schedule and 27.1 percent would often return to work with less than a 12 hour break.

The same survey revealed that 6.5 percent had suicidal thoughts and three percent had suicide plans.

Another national study of 893 paramedics in 2018 found that 55.9 percent suffered total burnout, 43.4 percent suffered patient related burnout, 62.7 percent suffered work related burnout and 69.1 percent suffered personal related burnout.

These figures make clear that problems with the workplace culture in Victoria are not confined to that state, but are prevalent nationally. The emphasis on productivity, regardless of the human consequences, has created a crisis everywhere.

Above all, the plight of paramedics is the outcome of the gutting of public healthcare by successive governments, Labor and Liberal-National alike, at the state and federal levels. As part of a broader onslaught on social spending and working class conditions, they have refused to provide the necessary funding for paramedics and every other aspect of the health system, while presiding over a massive growth in the wealth and profits of the corporate and financial elite.