Metrics details. High rates of mental distress, mental illness, and the associated physical effects of psychological injury experienced by ambulance personnel has been widely reported in quantitative research. However, there is limited understanding of how the nature of ambulance work contributes to this problem, the significant large toll that emergency medical response takes on the individual, and particularly about late and cumulative development of work-related distress among this first responder workforce. This study examined peer-reviewed qualitative research published from to to outline the effect of emergency medical response work on the psychological, psychosocial, and physical health of paramedics, ambulance officers, ambulance volunteers, and call-takers. The systematic review was organised around five key areas: impact of the work on psychological wellbeing; impact of psychological stress on physical wellbeing; how work-related well-being needs were articulated; effects of workflow and the nature of the work on well-being; and, effects of organisational structures on psychological and physical well-being. Thirty-nine articles met the eligibility criteria. Several factors present in the day-to-day work of ambulance personnel, and in how organisational management acknowledge and respond, were identified as being significant and contributing to mental health and well-being, or increasing the risk for developing conditions such as PTSD, depression, and anxiety. Ambulance personnel articulated their well-being needs across four key areas: organisational support; informal support; use of humour; and individual mechanisms to cope such as detachment and external supports. Interactions between critical incidents and workplace culture and demands have an overwhelming impact on the psychological, physical and social well-being of ambulance personnel. These include day-to-day managerial actions and responses, the impact of shift work, poorly-managed rosters, and long hours of work with little time between for recovery. Mental health issues result from exposure to traumatic events, and the way managers and peers respond to worker distress. Ambulance personnel suffering from work-related stress feel abandoned by peers, management, and the service, during illness, in return-to-work, and post-retirement. Policy, programmes and interventions, and education need to occur at an individual, peer, organisational, and government level. Peer Review reports. Ambulance personnel are essential first responders in the community. Across different countries and jurisdictions, they are known by a variety of terms such as paramedics, emergency medical technician, emergency medical personnel, emergency dispatch personnel and call-takers. Their role is to directly provide or coordinate the communication of response for out-of-hospital or pre-hospital emergency medical care in the community. Their contribution to the health and wellbeing of the community and to healthcare is overshadowed by more dominant dialogues and debates about community services, acute care and hospital emergency department tensions and resource demands [ 1 , 2 , 3 , 4 ]. In Australia, the nature of ambulance work, the uncontrolled and often unpredictable environments, the everyday experience of trauma, and the cumulative nature of that trauma all play a key role in the development and impact of mental distress and psychological injury [ 3 , 4 , 5 ]. In addition to the nature of the work, organisational and occupational factors such as workload, work demands, shift work, limited time for debriefing or downtime, the hierarchical nature of supervision, and the lack of recognition are clearly shown to have effects on the well-being of ambulance personnel that are as significant as, if not greater than, the nature of the work itself [ 3 , 5 , 6 ]. This paper examines the peer-reviewed qualitative research to outline the effect of emergency medical response work on the psychological, psychosocial, and physical health of paramedics, ambulance officers, ambulance volunteers, and call-takers. A broader Canadian study [ 8 ] of emergency response and correctional workers correctional workers, dispatchers, firefighters, paramedics, and police officers showed that Of added concern, under-reporting is thought to be a pervasive feature of this healthcare workforce [ 2 , 5 ]. Apart from psychological impacts, a range of physical impacts resulting from the nature of ambulance work and exposure to occupational stress have also been reported. These include headaches, sleep disruption, muscular skeletal injuries, fatigue, dietary problems, weight gain and, in some cases, exposure to dangerous pathogens [ 9 , 10 , 11 ]. The research therefore suggests that rates of mental distress, mental illness, and the associated physical effects of psychological injury experienced by ambulance personnel demonstrate the large toll that emergency medical response takes on the individual. These impacts included extended time off work and significant compensation for ongoing care and support. Claims were almost five times longer than for other serious claims for all types of injuries and illnesses, and monetary payouts for serious mental disorder for first responders was almost double that of all payments [ 12 ]. These statistics demonstrate the high cost in monetary value, lost productivity, and lost personnel which is experienced by Ambulance Services personnel and other first responders due to the effect of mental distress and psychological injury [ 12 ]. The predominant use of measures of stress and psychological injury which focus on current symptoms make the longitudinal screening of personal mental health and wellbeing difficult and potentially miss important information about late and cumulative development of work-related distress. This mismatch may result in failure to recognise and address adverse longer-term impacts of the work itself. It may also result in failure to identify effective evidence-based prevention measures or to intervene early to prevent potentially higher rates and prevalence of psychological distress in this group [ 6 ].

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