Making the Strong Stronger: An Investigation into How the Toronto Paramedic Services Address Staff Operational Stress Injuries

The Issue

We received a number of complaints from Toronto Paramedic Services (TPS) employees about TPS’ handling of operational stress injuries. The employees were disappointed with how they were dealt with when they experienced persistent psychological injuries arising from their work as paramedics and emergency medical dispatchers. Such injuries, known as Operational Stress Injuries (OSIs) included anxiety, depression, alcohol and drug dependency, and post-traumatic stress disorder (PTSD).

The complaints raised systemic issues, including alleged inadequate supports and services for members that may be impacted by operational stress injuries and insufficient organizational training and awareness on the topic.

Our Investigation

The investigation focused on the systems, supports, policies, and procedures the TPS had in place to address operational stress injuries for paramedics and emergency medical dispatchers.

We received a total of 123 complaints and submissions from members of the TPS as part of this investigation. This included hearing from emergency medical dispatchers, paramedics, supervisory, and civilian staff.

In total, we conducted 139 interviews – a record number of interviews completed as part of a single investigation. This included 40 interviews with complainants and 57 interviews with TPS staff, both current and retired. Investigators also interviewed 42 stakeholders, including jurisdictions outside Ontario and beyond Canada.

What We Found

The investigation found that TPS has in place the elements of a comprehensive psychological services program. However, those elements are insufficiently coordinated.  

• The role of the staff psychologist is not documented and unclear to some. The current psychologist has a number of duties, including short-term counselling, referrals, coordinating the PRT, responding 24/7 to critical incidents, and providing training and education to staff. Yet there is no strategy or framework on how to prioritize these functions.

• The role and responsibilities of the PRT is not documented in policy. There is also no protocol setting out when and how the PRT or psychologist should be notified of stressful calls or incidents. The Ombudsman found that members of the PRT are not trained in suicide prevention and that the TPS does not have a formal suicide prevention and intervention strategy in place.

• TPS is not immune from the societal stigma associated with mental illness.  This stigma permeates most of our organizations and communities.  In first responder, para-military and military institutions, the stigma is exponentially more pervasive because of the added “suck it up” attitude.  

The reality of societal stigma around OSI, coupled with the challenging work of TPS paramedics and dispatchers, means the TPS has the responsibility to continue making improvements. 

Our Impact

The Ombudsman made 26 recommendations, including nine related to improving the organizational structure for psychological services.