Background: High rates of mental distress, mental illness, and the associated physical effects of psychological injury experienced by ambulance personnel has been widely reported in quantitative research. However, there is limited understanding of how the nature of ambulance work contributes to this problem, the significant large toll that emergency medical response takes on the individual, and particularly about late and cumulative development of work-related distress among this first responder workforce. Methods: This study examined peer-reviewed qualitative research published from 2000 to 2018 to outline the effect of emergency medical response work on the psychological, psychosocial, and physical health of paramedics, ambulance officers, ambulance volunteers, and call-takers. Databases searched included: Ovid Medline, CINAHL, Ovid EMcare, PsychInfo and Scopus. The systematic review was organised around five key areas: impact of the work on psychological wellbeing; impact of psychological stress on physical wellbeing; how work-related well-being needs were articulated; effects of workflow and the nature of the work on well-being; and, effects of organisational structures on psychological and physical well-being. Results: Thirty-nine articles met the eligibility criteria. Several factors present in the day-to-day work of ambulance personnel, and in how organisational management acknowledge and respond, were identified as being significant and contributing to mental health and well-being, or increasing the risk for developing conditions such as PTSD, depression, and anxiety. Ambulance personnel articulated their well-being needs across four key areas: organisational support; informal support; use of humour; and individual mechanisms to cope such as detachment and external supports. Conclusions: Interactions between critical incidents and workplace culture and demands have an overwhelming impact on the psychological, physical and social well-being of ambulance personnel. These include day-to-day managerial actions and responses, the impact of shift work, poorly-managed rosters, and long hours of work with little time between for recovery. Mental health issues result from exposure to traumatic events, and the way managers and peers respond to worker distress. Ambulance personnel suffering from work-related stress feel abandoned by peers, management, and the service, during illness, in return-to-work, and post-retirement. Policy, programmes and interventions, and education need to occur at an individual, peer, organisational, and government level.

Women’s experiences of military service and transition occur within a highly dominant masculinized culture. The vast majority of research on military veterans reflects men’s experiences and needs. Women veterans’ experiences, and therefore their transition support needs, are largely invisible. This study sought to understand the role and impact of gender in the context of the dominant masculinized culture on women veterans’ experiences of military service and transition to civilian life. In-depth qualitative interviews with 22 Australian women veterans elicited four themes: (1) Fitting in a managing identity with the military; (2) Gender-based challenges in conforming to a masculinized culture—proving worthiness, assimilation, and survival strategies within that culture; (3) Women are valued less than men—consequences for women veterans, including misogyny, sexual harassment and assault, and system failures to recognize women’s specific health needs and role as mothers; and (4) Separation and transition: being invisible as a woman veteran in the civilian world. Gendered military experiences can have long-term negative impacts on women veterans’ mental and physical health, relationships, and identity due to a pervasive masculinized culture in which they remain largely invisible. This can create significant gender-based barriers to services and support for women veterans during their service, and it can also impede their transition support needs.

Disempowering experiences of military service and transition for women veterans exist within an established, dominant, masculinised culture, in which their presence is highly visible, challenged, and often subject to institutional prejudice. Sexual abuse of women in the military, in particular, is a persistent finding in contemporary international research and national inquiries into military culture in countries such as Australia, the United Kingdom (UK), the United States (US), and Canada. This study sought to understand military service, transition to civilian life, and post-military experiences of Australian women veterans, specifically their experiences of discrimination, military sexual harassment and assault, and consequent military sexual trauma (MST). In-depth qualitative interviews were undertaken with 22 Australian women veterans that examined how women veterans manage their identity as women in the military. Issues included gender-based challenges in conforming to a masculinised culture, experiences of misogyny, sexual harassment and assault, systemic failures to recognize women’s specific health needs, and experiences of separation from the military and transition, including help-seeking and engagement with services to address their experiences of MST. Women veterans’ adverse experiences largely stemmed from an entrenched masculinised military culture, in which military sexual assault was enabled, ignored, and condoned. Military and veteran support services have been slow to recognize, acknowledge, and address this significant issue.

Changes in service delivery and Australian mental health legislation have expanded the role of paramedics in caring for persons experiencing a mental health crisis. The expanded role of paramedics is reflected in Clinical Practice Guidelines (CPGs) and varies across ambulance services. We examine Australian paramedic CPGs to identify guidelines for managing mental health crises, citations, assessment tools, treatment options (e.g. de-escalation, restraint), and recommendations. Mental health is outlined in a range of CPGs, but is most often associated with agitation and disturbed behaviour. Legislation and legal documents are frequently cited in the CPGs, reflecting the significant influence of legislation on paramedic practice. There are differences between ambulance services in their approaches to mental status assessment, de-escalation, and restraint; however, there are commonalities in the underlying principles. There is limited publicly available evidence to enable evaluation of CPG development. Care of persons experiencing a mental health crisis requires flexibility and clinical judgment on the part of the paramedic, making it a challenge to be prescriptive. Ambulance services operate under the current mental health legislation in their jurisdictions, resulting in variations in practice, as documented in the CPGs.