Psychosocial hazard exposures and mental health outcomes among ambulance Emergency Medical Technicians in Ghana: A qualitative phenomenological study

Emergency Medical Technicians (EMTs) face elevated risks of physical, mental, and psychosocial harm owing to the demanding nature of their work. Despite extensive research on the impact of emergencies on victims, the psychosocial hazard exposures and well-being of EMTs who respond first to these emergencies remain underexplored. We adopted an interpretative phenomenological approach to investigate psychosocial hazards and their associated mental health and work attitude outcomes among EMTs in Ghana's National Ambulance Service (NAS). In-depth interviews were conducted with 13 EMTs from seven of Ghana's 16 regions. Reflexive thematic analysis uncovered three core themes regarding the psychosocial hazards EMTs are often exposed to: "Bearing the Burden" which reflects the physical, emotional, and ethical strain of ambulance work; "Systemic Strain" which captures the institutional gaps and resource limitations that hinder effective emergency response; and "Between Stigma and Support", which encompasses the complex social dynamics and public perceptions that shape EMTs' professional experiences. These exposures resulted in negative outcomes, such as psycho-emotional distress (e.g., vicarious trauma, moral injury, fatigue, and depression), as well as positive outcomes, such as posttraumatic growth, resilience, and religious coping. Regarding the impact on work attitudes, participants reported lower job satisfaction and higher intention to quit. These findings have implications for enhancing EMT well-being and prehospital ambulance emergency care in Ghana and lend credence to the dual nature of psychosocial outcomes in high-risk work environments. To reduce these hazards and improve EMTs' well-being and resilience, psychosocial support should be integrated into organizational policies and EMT training.