Paramedic Trauma And The Moment It Hit

A lot of people assume first responder stress is mostly about what you see on calls. Emma Irwin, a UK paramedic who worked both London and Kent, helps us name the other half of the story: the system you work inside. We compare how ambulance “trusts” operate, what shifts when call volume spikes, how response targets change the feel of a day, and why a 30-minute transport can be a big deal when it reshapes decisions about hospitals versus community care. If you care about EMS leadership, paramedic wellness, or first responder mental health, these details are the difference between surviving a career and being quietly worn down by it. 

We also get honest about mental health services and the messy middle between “help exists” and “help works.” We talk NHS talking therapies, long waiting lists, and why people sometimes miss appointments or struggle to engage even when support is offered. From there we move into therapy fit, trust, and what happens when your options are limited, whether you live in a rural area in the US or a crowded city with overwhelmed providers. 

The conversation turns deeply personal as Emma explains how cumulative exposure builds over time, especially for clinicians who began during COVID, and how one unexpected call can flip the switch into PTSD. We don’t treat trauma like a headline. We treat it like a real nervous-system response that deserves real follow-up care, not just emergency crisis intervention and a quick return to duty. 

Subscribe, share this with a first responder who needs it, and leave a review so more police, fire, EMS, and dispatch listeners can find these conversations.

DeemedFit: First Responder Owned
We are a first responder owned company looking to get first responders in the best mental shape.

Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.

Transcript

SPEAKER_00 0:01

Welcome to Resilience Development in Action with Steve Bisson. This is the podcast dedicated to first responder mental health, helping police, fire, EMS, dispatchers, and paramedics create better growth environments for themselves and their teams. Let's get started.

SPEAKER_03 0:29

Well, hi everyone, and welcome to episode 248. If you haven't listened to episode 247, it was with Kimmy Sadler. She was a former supervisory special agent in the U.S. State Department. And she is on her way walking around Europe in order to support the first responders out there. So having said that, I have someone we met through online, and I was like, oh, this is great. I want to meet her. And we kind of connected fairly quickly, and she's finally on here. When I hear England, I've had a few people from England, I and I think that it's important for us to have a first responders perspective from England because sometimes it is the same yet different. And for the record, I did look at this beforehand, and I'm not this is just because something someone else triggered me because oh, it's different in England, it's easier. And I'm like, well, the suicide rates of first responders in England are pretty much the same as the one in the United States. So it's different, but the same. That's how I perceive it. But Emma Irwin, welcome to Resilience Development in Action.

SPEAKER_01 1:32

Thank you. Thank you for having me.

From Criminology To Paramedic Work

SPEAKER_03 1:34

It's always good to have someone like talk about what they've done when they retired, because one of the things that I talk about all the time is that get ready for your retirement because it's a loss of role, and a lot of people forget to get ready for that retirement. But I don't think we're going to jump down that right away. I feel like I read a little bit of your bio. Obviously, we met through online. So I want to learn more about you. So tell me a little more about yourself.

SPEAKER_01 1:57

Tell you about myself. Well, I'm 33 years old. So I've retired in the sense that I've given up that position on the front line, but unfortunately, I can't afford to tie from working at this age. I still need to work. So I moved into like I'm still working as a paramedic, but in an office role. So very much not frontline. I'm now assessing disabilities for benefit systems. So that's what I'm doing as a clinician. But I was born in south east of England in Kent in a little town called Seven Oaks. And then we moved to the southeast of London. So I grew up around around Kent and London.

SPEAKER_03 2:33

Okay.

SPEAKER_01 2:34

And I went to university and did a degree in criminology. And I wanted to be a police officer initially. That was so I always wanted to be in the emergency services, and my dad was an inspector in the Metropolitan Police in London. Most of my family come from some sort of emergency service. My mum's a dentist, so she's medical. So yeah, I think I was destined for some sort of frontline role. My brother's a firefighter, so we've got it all going on. But yeah, I did a degree in criminology, and then I don't know, I just stepped away from that. And a position came up in the London Ambulance Service for like an apprenticeship role. So I joined as a technician and I was trained up as a technician and then through the ambulance service, they sort of funded a degree to become a paramedic and take that extra step join there. So while I was doing that, I moved down to Ashford in Kent. I've got two dogs.

SPEAKER_03 3:30

Okay. What's your name? Kevin and Phoebe, we better I'm I'm gonna I'm gonna make sure we get some pictures so I can put that on.

SPEAKER_01 3:39

Of course. Don't mess with Kevin. Kevin's a golden retriever.

SPEAKER_03 3:42

Okay, yeah. Well I'm always a Labrador.

SPEAKER_01 3:45

He's oh, he's terrifying. Yeah, absolutely terrifying. He's a nightmare. You might hear him in the background at some point demanding attention. But yeah, now I live, I'm about 20 minutes from the sea, which is nice. I really like living down here. And yeah, I moved to Southeast Coast Ambulance Service from London Ambulance Service. So it's it's amazing how different ambulance services are, even in well, one local area of of England, even totally different to work for. So I was working with CAM for a couple of years, and it really took me that long to get used to them. I'm a little slow. Sorry, Southeast Coast Ambulance Service.

SPEAKER_03 4:23

Thank you. I'm I'm I'm not I don't know.

SPEAKER_01 4:25

No, no, no, I should have said that. So yeah, that was the ambulance service I moved to in Kent, so the Southeast Coast, they cover Kent, sorry, Sussex in England. And yeah, I left there in December 2025. So I've just left and joined my new role as a disability assessor.

SPEAKER_03 4:42

Well, a few things that you said I want to make sure I address. They're still retired. I have my younger guys and younger women here who are retired. They're retired. That doesn't mean they're retired from life, they're just retired from their job.

SPEAKER_01 4:55

Just yeah, just from that job.

SPEAKER_03 4:56

Sometimes a job will retire you, you know.

SPEAKER_01 4:59

So I think these type of jobs do sort of earlier than others, don't they?

London Versus Kent On The Job

SPEAKER_03 5:05

I that's my experience. So that's why, like, while you said, Oh, you know, but I'm still working, yeah. Well, you're still retired, because you know you know, so one of the men like you you talked about being a paramedic down in you said London and a little bit in the southeast of England, and how different it is from one space to another. I know around here I feel like urban areas, such as Boston, New York City, stuff like that, are way different than you know, I'll pick on Poughkeepsie in uh New York, or shout out to where are my office in Holliston, Massachusetts. There there's a huge difference, even though one's suburban and the other one's urban, and there's definitely different types of presentation, even though there are some things that are similar. Is that what is what what would you say is that like, you know, what is it to be a paramedic and the differences between the two areas?

SPEAKER_01 5:58

So I think I don't think we necessarily have that urban and sort of countryside rural differences. Like I think in America you have vast differences in locations, don't you? You have big spaces where there's not a lot going on, very, very small towns. I think in England you don't have that as much. I think you know, within half an hour's drive, you're at another big town. So you don't really have that divide between urban and rural. So the jobs in themselves don't necessarily change much from area to area. I found in London a lot of my jobs were mental health that I went to, a lot of poor mental health within London. I don't know if that's because it's a more built-up urban population with more sort of social housing and benefit systems, more people living there. I found that a lot, whether that was just my area. Moving out of London, bigger, faster roads. So there was more sort of trauma on roads around Kent because you've got the motorways. In London, nothing's going more than 20 miles an hour. You might get sort of pedestrians being hit, but they're not going to be hit fast. You don't get a lot of trauma in that sense. So that was a bit of a different job further out in a more rural location. Um, it's more how the trusts, because I don't know how it works in America. I think you have you have private ambulances services, don't you?

SPEAKER_03 7:22

Sort of depending on the area, some of them are private and some of them are integrated within the fire service.

SPEAKER_01 7:28

Yes, yeah. So they work at the fire departments. Yeah, in England you have trusts. So the ambulance services are not linked to hospitals, but you'll have have ambulance trusts. So each area of the UK will have an ambulance trust. I don't actually know how many they are, but so London is its own trust, and then South East Coast Ambulance Service is the trust I moved to. So they cover three counties in Kent. So each region will have a trust, and they just work very differently. And I guess it's just the needs of the population they have. In London, a lot of people have a lot more call volumes, so they have different sort of policies, different time limits on jobs. We have time limits for jobs, how long we should be spending on scene, sort of targets. And although you know, you cannot you can you need to spend with someone what you need to spend with them, so they're not sort of you have to leave once the target is here, like just leave them there. But they do have the target bag. Yeah, yeah. They don't have sort of target. I know you we'll come back later. Call again.

SPEAKER_03 8:34

Get sick again, we can come back.

SPEAKER_01 8:36

Yeah, it's not quite that bad. But they're not as strict with them in London, I think, because they know the pressure you're under. In CAM, where I moved to in Kent, they're a bit more strict with their targets, and I think that's because you're not you haven't got as high a call volume. So you know, you should be able to to get more done in a day and to have more headspace to focus on on your job a bit better, really. Another thing that's different is just the layout of the trust itself. So, for example, in Southeast Coast Ambulance Service, I think because of the journey to hospital times are longer, not gonna be as long as in America and your rural areas, but in regards to London, you know, we might have a 30-minute drive to hospital. That's quite a long time for us. It's a long journey to hospital, and so to avoid unnecessary journey to hospitals and wasting that time, there's a lot more community services. So I could refer to a lot more people and get a lot more help in the community than I could in London. They didn't really have that there's too many people, there's not enough services to the people there, and they're like five minutes from hospital, so they would just go to hospital, but then that would mean that you're queuing in London hospitals because there's no beds for your patients for up to 12 hours a shift. So um, when I was in London, most of my shifts were spent queuing at hospitals in um the southeast, we didn't have any of that. So just the way the needs of the population are, the way the hospital everything's just so different, and I just wasn't wasn't expecting it when I moved. There's good things and bad things about both, I would say.

NHS Waits And Mental Health Demand

SPEAKER_03 10:11

I I think uh yeah. So yeah, let's just for our American buddies, which is mostly what listens here, just for the record, knowing what social medicine can do, living in Canada and most of like for my first 24 years of my life, knowing a little bit about England and how it is, it's good to have access to hospitals to everyone. However, if you're willing to wait. And people hear like, oh, I waited six hours, eight hours. I'm like, you know how many like English, Canadians, or Australians would be like, that's nothing.

SPEAKER_01 10:46

I and I always say, you know, if you need to wait that long, then you probably don't need to be in hospital. That's what I know. And you know, when people would complain at me about the wait times, I'd say, you know, you'd be you'd if you if I were you, I'd be more concerned if you're being seen in the first 30 minutes. So, you know, it's a good thing. You're not particularly unwell. It's frustrating, but you know, you need to look at it the other side. The reason you're waiting that long is because other people need to be seen quicker than you. So yeah, but the wait times are they they're insane here. There's there's too many people, there's not enough hospitals, not enough infrastructure, it it gets worse and worse every year. But it's been like it for years. It's I think it's in the news more in recent years, probably since COVID, let's be honest. But uh it's been like it for years. People have said how you know busy the system is for years and years and years. I don't think there's anything massively different other than people are I think people are becoming unhealthier as well.

SPEAKER_03 11:43

I mean, the aging of the population plays a factor too. I don't want to go into too much demographics, but you know, you know, like Western cultures now we're getting elderly type of population. I mean, the baby boomers are all turning 65 this year, like Yeah.

SPEAKER_01 11:57

You know, people are living longer, a lot more mental health as well. A lot more mental health, which was one of the biggest problems, I think. Yeah, and there's not enough services in the UK. Our mental health services uh I'm not I wouldn't say they're bad, but there's not enough for the demand. So the only place really is to take people to hospital, which isn't I know you're not saying it's bad, but I'm saying that's bad. So I'm saying it yeah, yeah. It's not it's not as it should be. It should be better. Mental health services are not good.

SPEAKER_03 12:25

Maybe it's a better question to ask this. Maybe you can uh help me with this. Is it that we don't have enough services for mental health, or is because mental health has become more of something we can talk about, then the services aren't there?

SPEAKER_01 12:38

I think people are talking about it more, people are self-diagnosing a lot. I think social media is is causing a lot of people to think they have a mental health problem. I don't think people understand what a mental health problem is. You can have struggles in life and not have a mental health problem. You know, you you can have days where you're feeling low, you you can be anxious and not have a mental health problem that needs diagnosis and treatment. And I think there's a bit of a blur there for especially young people with social media. But I also think that, well, from what I noticed on the ambulances, the problem is a lot of people don't engage with mental health services. So they might be there, but but they don't engage with them. And so there's there's only so much those services can do, and then that's put out as I'm not getting any help. But I I would have uh patients say to me, you know, I'm not nobody's helped me with this mental health problem, but I'd see that they've missed three appointments, and I you know, I say, but you you're not engaging with them, there's only so much they can do if you're not turning up to your appointments. So I think that's a big part of it is people not engaging, but then there are people that really haven't had the help that they should have had and have sort of fallen through nets. So I think it sort of goes both ways. I don't think the services are perfect, but I don't think people understand how the services can help them either.

Why People Skip Treatment

Sponsor Break Deemed Fit Discount

Finding A Therapist Who Fits

SPEAKER_03 13:59

Just a quick break, guys. I'm gonna talk about a new product that I really like. I actually bought one of their hoodies, it was amazing, and I really enjoyed wearing it. Um this episode is gonna be supported by Deemed Fit. Deemed Fit is a first responder-owned activewear and a leisure brand. And one thing that I genuinely like about them is that they support different causes. I actually gave a few people I know who work with first responders, our nonprofits, their name to uh Deemed Fit, and I know they're talking to them. They do a lot of initiatives and collections that are based on mental health for first responders. And if you go there right now and you buy anything, including the mental health support stuff, uh use the code R D A 15. That's right, R D A 15 to get 15% off on any products that you get. Again, it's called R D A 15. Go to dfit.com, D-E-E, M-E-D, F-I-T.com, and enjoy 15% off at checkout to save. Now, right back to the episode. And I agree with you, Emma. I I think that that's the biggest problem, too, is that you gotta find the right fit. And I think that one of the things that I've seen around here, not only in my area, but when I work for a bigger company where we did telehealth. If you're in Idaho, I'm just picking on the US for a second, and there's like three providers within a 20-mile radius. Well, if you don't like those three providers, you're kind of up shit's creak without a paddle. And I find that, you know, the other part too that people don't understand about therapy is that while we are all trained the same, I'm not everyone's cup of tea. I mean, I'm a nice guy, but that doesn't mean you like me. Yeah, I hope you do like me, Emma, but if you don't, it's okay. I'm not your therapist.

SPEAKER_01 15:44

I don't need one of those anymore.

SPEAKER_03 15:46

But the point is is her session after this, people. I don't have a bow in England, so we're good. I'm kidding. I'm kidding, everyone. I'm kidding. But no, I think that that's the other part too, is that finding the right fit, and that's the other thing too, is that if the therapists that you have access to are not your cup of tea, you're a woman who is it.

SPEAKER_01 16:07

That's your help sort of gone. Yeah, there's no like, oh, let me find you another one. It doesn't work that way. So no, I agree with that. And and you're not going to engage if you're not sort of on the same page as your therapist.

SPEAKER_03 16:20

And why would you engage if you don't have trust? I mean, that's the other part.

SPEAKER_02 16:23

Yeah, understand.

SPEAKER_03 16:24

You know, so I think it it's a conversation I had recently with another client. She has couples counseling, and she was saying to me that you know, they were wondering if we've been working together for too long. I'm like, well, that could be it. I don't know. Are you comfortable with me? Are you feeling like you're holding off or you feel like you're trying to please me in any way, shape, or form or whatever? And she said no. And then I said, then that's probably a good match. We're still good. If we start changing our style in order to adapt to the front person in front of us, that's when therapy is no longer working.

SPEAKER_02 16:55

Yeah.

SPEAKER_03 16:56

I I think but you need to have that match because if you don't have that match, I've met a lot of people who are really needed the help, but I definitely wasn't their cup of tea. And that there's nothing wrong with that. I gave them other referrals, but we face the same problem in in the United States that we do in Canada and England. And frankly, what I hear most of Europe is that you have a limited number of people.

Suicide Hotspots And Crisis Gaps

SPEAKER_01 17:17

Yeah, exactly. And too many people needing the services these days. But yeah, it's it's difficult. It's difficult. Where where I live in Ashford, the hospitals on a motorway with multiple bridges, and there's there's a lot of suicides in Ashford. It's really common on the on the bridges of the motorways. So there's sort of signs all over the bridges from Samaritans, and you know, so we have they they do put things in place very quickly. So once there was a there I really only started recently the suicides, those signs only went up recently. I think once we had a few in a row, they're quite good at getting emergency help. I would say that's quite good in the UK, that emergency crisis help. But then it's once that crisis is over, there's just sort of no more help. It'll it'll just go round in circles.

SPEAKER_03 18:07

Well, you know, that I can go on and on about that too, because it yeah, you get a lot of like emergency help, but to because you need emergency help, something led you there, so you gotta address that stuff so that you don't repeat it. Yeah, you don't have that. You're gonna do it again.

SPEAKER_01 18:22

Waiting lists, you know, there's waiting lists for everything. I mean, when I had my therapy, which we will get to, I had my therapy through the ambulance service. So that, you know, I was lucky and I was in a job where I had access to that. But before I went through the Ambulance Service, I went through just the NHS, the National Health Service, for anyone that doesn't know. And they have talking therapies. And the waiting list, it was like eight weeks long, which I mean it might not sound massive, but if someone's someone can deteriorate massively in that eight weeks if they're having, you know, a real mental health crisis.

SPEAKER_03 18:55

You know, as much as I do, you in paramedic stuff, right? If you got an acute situation, you can't just say, you know what, we're gonna slap a band-aid. You gotta kind of like do the harder work, but then it's still afterwards there's rehab, there's this, there's that. You know, that access.

SPEAKER_01 19:12

Yeah, like I didn't have any emergency symptoms, obviously. They do triage for someone that needs immediate help, but you know, I I think I would have got quite a lot worse quite quickly if I didn't get like therapy when I did, to be honest.

SPEAKER_03 19:26

So I hope that people heard that. People who are paramedics sometimes need therapy.

SPEAKER_02 19:32

Just say sometimes I need therapy. One of the things you mentioned.

The Call That Triggered PTSD

SPEAKER_03 19:36

I I just heard you mention suicides in your uh that that have become repetitive. I I used being a a a suicide prevention person from the past, I'm no longer doing that. I know a whole lot about that, but let's let's move from the suicide in a sense that maybe that's not the sub what you're gonna answer here. But you you know, everyone has that one trauma that kind of triggers them, you know. Oh my god, I really need treatment because I just saw a dead cat on the side of the road. And and I say that because it's less triggering for people. I try not to trigger my c my my audience right away. I wait till they meet me. But sorry, everyone. Well, let's talk about your paramedic stuff. What was the trigger for you? What was that event that kind of triggered you?

SPEAKER_01 20:21

Yeah, so I think with trauma, there's two types of triggers. You've got like long-term, frequent triggers, like multiple traumas, and then you've got like one traumatic event. And I think I, you know, I have no trauma from my childhood. I had a very good upbringing. I've I've had a very easy life in terms of mental health. I've never really suffered with any mental health problems, I've never had anything happen in my life that would cause any sort of trauma. So I went into this job with a very untraumatized person. And then I think so. I had one event that set off my trauma last year. I think in the ambulance service, anyway, just everything you go to builds up a sort of trauma. And I found during COVID, so I started as a technician in 2019. So I started just as COVID was coming into play. So my whole career was COVID. And during COVID, so during 2020, I was not quite qualified, but I was out on my own sort of training, and I was meant to be with another clinician, but I was actually put with a fireman because they needed extra trucks out. So I wasn't even qualified, and I was put with someone with no medical knowledge at all, so I had to learn very quickly. And so I think little things like that affected me throughout the years, but these aren't things that I noticed at the time, and I think small things like watching people say goodbye to family members or going to elderly people who are lonely and you're having to leave them alone, those things affected me the most in this job over time. But I had one event which was I can't do that. Away too much about it. But basically, I went to a lady who had hung herself whilst at home with her ch her young children. And so her young children had found her in the morning. And I think the reason it traumatised me so much was because I didn't know what I was going to. And I don't know if this will make sense to a lot of people who've worked on the front line, but you normally you get the job dropped down, don't you, on your internal ambulance computer and you see it's a hanging or you see it's someone that's been hit by a car or or someone you know that's given birth, and you sort of you build up a bit a bit of an idea of what you're going to and you prepare yourself. And so this one it came down as it came down as someone who had been found dead, but it didn't have any more details. So I think when we got there and found a young person, relatively young person who had hung herself and there was five or six kids on scene, I think it was just quite a shock. And I got upset on scene. And I I never I don't cry on scenes, and I got upset while I was on the radio asking for more resources and sort of police, and I started crying, and that's what brought on the sort of PTSD, me crying on scene, which just sounds crazy, doesn't it?

SPEAKER_03 23:17

Well, let me do this. You want to stick around for another half hour? Because I want to address what you just said, but we'll go through the other half hour if you don't mind.

SPEAKER_02 23:24

Yeah, yeah.

SPEAKER_03 23:25

All right, so guys, just join us for the next part of the episode. I don't mean to interrupt a great story, but I I want to get back to that. So please join us for the next episode.

SPEAKER_00 23:36

Please like, subscribe, and follow this podcast on your favorite platform. A glowing review is always helpful. And as a reminder, this podcast is for informational, educational, and entertainment purposes only. If you're struggling with a mental health or substance abuse issue, please reach out to a professional counselor for consultation. If you are in a mental health crisis, call 988 for assistance. This number is available in the United States and Canada.