The Female Emergency Medical Services Experience: A Mixed Methods Study

Figures & data

Table 1. Identified themes, subthemes and impactful quotes from female EMS clinician focus groups.

Theme	Sub-theme
The female EMS experience	Sexism “Oh no, no. You’re a girl. You shouldn’t talk like that, or you shouldn’t do that.” “Women are still pushing to make a presence in the EMS world like we still have a hard time struggling to prove that we’re just as qualified or just as equal as the men that work.” “I'll walk in with a male partner…the people think that he’s in charge and also, I'm a critical care medic. So, I have like the patch on and everything and the doctor will just immediately start talking to my male partner.” Harassment “And a lot of patients, partners, other clinicians do not respect our personal space. I've had multiple people on jobs, literally walk up to me and just touch me without my consent.” “…it took me a week to speak with HR… I love my job. I love it to death. I pick up over time left and right, and I love my coworkers. And I was like, scared to come into work, and I was so anxious. I was like, worried. I'm gonna get singled out.” Pregnancy and Maternity “So, one of two things happen. Either you end up having a miscarriage or you go out on disability ‘cause you just can’t take it.” “So, I'm currently pregnant and within working I have struggled to find reasonable accommodations or, you know, even with a written doctor’s note, I was denied a different position or a different job task,” and “And when we ask like, why are there no accommodations for women who are pregnant like you either have the choice of putting your life or your child at risk or coming to work very close to the end of your pregnancy to make sure you have insurance.” “And when we talk about pregnancy and children, we also will get penalized, especially as women and mothers. I've seen so many mothers like ‘I can’t find childcare’. Like ‘I don’t know what to do’. Like,’ you know, my child got sick’ and it’s like, oh, we are ‘calling out too many days’.” “I’ve actually spoken to women who are like, alright, like, ‘I kind of wanna have a baby, but I can’t afford to right now because I have to go on light duty or I won’t be able to work for X amount of months, and you know my family can’t sustain that without my income’…So you have to be like, all right, well, maybe I have to find another job. I have to put off being pregnant.”). Interactions with male partners/peers “…I’ve generally had a pretty positive experience being a woman in this field. I don’t know if I’ve gotten lucky with the partners I’ve gotten to work with that have all been, uh, good friends to me…respectful partners, I feel like.” “I've also had partners like stick up for me, my male partners, when men did get inappropriate, which I always appreciate and you know, I believe I can hold my own at the same time, but it’s still nice when somebody steps in.” “So far, I've, I've definitely felt like most people are very accepting of having a female partner. I've never felt like I've had to, like, prove myself or anything like that.”
Impact on personal wellbeing	Job demands “Sorry, but kinda sometimes there’s like not a minute to think. You just keep doing and then you just have to push. It sucks. It’s, it’s not fun. There’s things that come home or days that get in my car and I just cry.” “…I had a 17 stair carry up the other day, 220 pounds and five steps to the top. I maxed out. I couldn’t lift anymore. Thank gosh my partner was able to carry up the last five stairs.” Impact on family and friends “I know for me I've almost ended up divorced on more than one occasion. I mean, sometimes you just can’t leave it. Well, sometimes we just can’t leave it at work.” Disappointment/frustrations “So, I understand the frustration because they [EMS leadership] don’t, you know, they see the problem in the moment if they choose to see the problem, and then it never goes anywhere. It gets highlighted and, and they maybe address it for that one person, but systematically the implementation of something or a program that would actually fix some of these things [pregnancy/maternity related issues] or alleviate some of these stresses, there’s not a lot of follow through.” Trust/mistrust “You know, everyone’s like, ‘Oh, mental health, mental health’ and, and then you have somebody with a legitimate issue, and you just drop the ball on that. It really feels like, ‘OK, you’re just saying this in name’. So, it’s very hard for me to have any kind of trust in management to think that you’re gonna get anything done. I'd rather take care of it myself for the most part.”
Impact on occupational wellbeing	Questioning of occupational abilities “…you’re looked at as if you can’t do this, you can’t do that. You’re only good for this, but you’re here.”  “And it was just really overall, you know challenging I got questioned while that work whether or not my judgment was off because I was pregnant.” Questioning of career choice “It’s kind of sad to look back and remember, you know, that I used to feel like I had all this room for growth and now feel like maybe I'm limited and maybe I need to choose a different career path where I don’t need to lay on my stomach to intubate while I'm pregnant or I don’t need to carry somebody into their chair. Umm, you know or where I can actually ask for help and not be judged because I'm a female….I don’t think I really had a doubt whether or not I was continuing with EMS for the rest of my life. And now I do.” “…initially when I had started here, I really was looking forward to just continuing through the path and you know, leading up to a supervisor and you know, I think that’s pretty much where it ends for woman. You know, administrator would always be nice, but we don’t see any women administrators for our department. “ Lack of support “But again, from management I really don’t get the sense of especially upper management that they really want to fix anything.” “And our leadership should back us on that [inappropriate behavior] and our leadership really needs to start backing US better.”
Coping mechanisms	Maladaptive coping mechanisms “You lack sleep. We don’t take care of ourselves when it comes to eating. And I mean, they’ll go hours without realizing that I haven’t eaten because it’s so busy. And like, if you don’t bring food to work, the chances you stop to get food are so slim to none.” “So, like the other day, my one bad habit I do, do to cope is I smoke cigarettes, you know? So in between calls. Like, that’s like my 10 min of peace and silence sometimes.” Adaptive coping mechanisms “So, I have no problem and admitting that I started going to therapy and now I look forward to going to therapy weekly because it has been my outlet and I get to you know, talk about my feelings based around work, judgment free or not, have to be worried about how management or supervisors would, you know, take how I'm feeling.” Peer support “As a group, EMS in general, we always look out for each other even if you don’t know the person. We tend to look out for each other because we have similar shared experiences.” “Like I'm just getting naturally a little bit more comfortable with female partners than I do with males. And I, I just, I don’t know if that’s like just a, you know, a woman-on-woman thing or if it’s just me knowing that I at least have an ally.” “So, I definitely think that’s important, just like, you know, having a partner that you can like vent to and like, you know, not drag them down with you but to just vent to it.”

Table 2. Female EMS clinician quantitative survey results (n = 161).

	Total
Variable	N	%
Age (median, IQR)	32	25-42
Race
White	140	88.6
Other	18	11.4
Marital status
Single/divorced/ Separated/widowed	59	37.3
Married/partnered/ in a relationship	99	62.7
Ethnicity
Non-Hispanic	141	89.2
Hispanic	17	10.8
Number of individuals living in house <18
0	73	46.8
1	38	24.4
>1	45	28.9
Number of individuals living in house >18
0	124	79.5
1+	32	20.5
EMS Certification
EMT	86	55.1
AEMT	9	5.8
Paramedic	41	26.3
CC Paramedic	14	9.0
Field supervisor	6	3.9
Location
Northeast	144	90.6
Other	15	9.4
Years worked (median, IQR)	7	3--16
Workload (pt contacts/day) (median, IQR)	5	3—7
Mental Health Measures
Occupational Stress (SOOS-14) (mean, std)	32.7	11.7
Probable anxiety	108	70.1
Probable depression	83	53.9
Elevated symptoms of burnout	64	41.8
Resilience (STARS) (median, IQR)	17	15—20

Table 3. Female EMS provider occupational experiences (n = 161).

Occupational Experiences	N	%
Have you ever experienced sexism while working as a female EMS provider, yes	120	76.4
*Sexism perpetrated by:
Patients	100	44.6
Hospital visitors	13	5.8
EMS partners or coworkers	96	42.9
Supervisors	61	27.2
Hospital staff	37	16.5
Other	24	10.7
Have you ever experienced harassment while working as a female EMS provider, yes	114	72.6
*Type of harassment experienced:
Verbal	106	47.3
Physical	42	18.8
Sexual	62	27.7
*Harassment perpetrated by:
Patients	95	42.4
Hospital visitors	13	5.8
EMS partners or coworkers	80	35.7
Supervisors	40	17.9
Hospital staff	21	9.4
Other	10	4.5
Have you ever experienced a pregnancy while working as an EMS provider, yes	39	24.8
Do you plan on having children while working as an EMS provider, yes	41	35.3
Have you had to delay or reconsider family planning because of your occupation, yes	45	38.8
Has being an EMS provider negatively impacted your relationships with friends and family, yes	69	44.5
Has your clinical judgment ever been questioned by a partner or colleague, yes	96	61.5
Do you believe it was because you are female, yes	45	46.9
Have you ever questioned or reconsidered your career in EMS, yes	96	61.5
*Reasons behind reconsideration
Workplace culture and/or environment	67	29.9
Previous negative experience	33	14.7
Lack of career advancement opportunities	57	25.5
Lack of workplace accommodations	33	14.7
Lack of organizational support	44	19.6
Other	18	8.0
Overall, how would you rate your interactions with your male EMS peers/partners, Very good/Good	112	71.3
Overall, how would you rate your interactions with your female EMS peers/partners, Very good/Good	121	77.0
Overall, how would you rate your interactions with your male EMS leadership, Very good/Good	92	59.4
Overall, how would you rate your interactions with your female EMS leadership, Very good/Good	105	66.8
To what extent do you feel supported at work by leadership, Completely supported/Somewhat supported	88	55.7
To what extent do you feel supported at work by your peers/coworkers, Completely supported/Somewhat supported	109	69.9

*Questions were asked in a check all that apply format and may not add up to 100%.