Emerg Med J 29:222-227 doi:10.1136/emj.2010.099838
  • Original article

Symptoms and responses to critical incidents in paramedics who have experienced childhood abuse and neglect

  1. Maria Gurevich4
  1. 1Department of Psychiatry, Mount Sinai Hospital, Toronto, Ontario, Canada
  2. 2University of Toronto, Toronto, Ontario, Canada
  3. 3Sunnybrook-Osler Centre for Prehospital Care, Toronto, Ontario, Canada
  4. 4Department of Psychology, Ryerson University, Toronto, Ontario, Canada
  1. Correspondence to Dr Robert G Maunder, Department of Psychiatry, Mount Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, ON M5G 1X5, Canada; rmaunder{at}
  • Accepted 5 February 2011
  • Published Online First 21 March 2011


Background Mental and physical symptoms are common in paramedics, which may relate to high work stress, including critical incidents. As previous trauma is a risk factor for psychological symptoms after exposure to critical incidents, the prevalence of childhood experiences with abuse and neglect and paramedics' adaptation to critical incidents may be important.

Methods 635 paramedics were surveyed regarding childhood experiences of physical, sexual or emotional abuse as well an index critical incident from the past, acute stress responses to that event and current mental and physical symptoms. A comparison group of 159 female hospital-based healthcare workers completed the same survey of childhood abuse and neglect in a separate study.

Results 232 paramedics (36.5%) responded. Among these, physical, sexual or emotional childhood abuse was reported by 38.4%. Female paramedics reported significantly more emotional and physical abuse and neglect than female hospital workers. Paramedics who reported childhood abuse or neglect more frequently experienced signs of acute stress immediately following the index critical incident and for the following 2 weeks. Childhood abuse and neglect were associated with significantly higher scores for depressive symptoms, physical symptoms and burnout, and a higher prevalence of ‘cases’ scoring above thresholds of clinical significance.

Conclusion Childhood abuse may be more common in paramedics than in other healthcare workers, at least in women. Childhood abuse and neglect is associated with acute stress responses to critical incidents and to current physical and mental symptoms. These results are based on a low response rate and may not be generalisable.


  • Funding This study was funded by the Tema Conter Foundation.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Sunnybrook Health Sciences Centre, Toronto, Canada.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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