ArticleThe western journal of emergency medicine2021
Suicide Among the Emergency Medical Systems Occupation in the United States.
Article in The western journal of emergency medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 4 of them syntheses that pooled it.
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Who cites it
8 citing papers in PubMed, 4 syntheses or guidelines pooled it, 17 citations in OpenAlex.
- Exploring the experiences, views, and needs of family members of emergency response workers: a systematic review and meta-synthesis.European journal of psychotraumatology · 2026Pooled it
- Silent crisis on the frontlines: a systematic review of suicidal behaviors among disaster responders - epidemiology, risk pathways, and evidence-based interventions.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Pooled it
- A Systematic Review of Associations and Predictors for Job Satisfaction and Work Engagement in Prehospital Emergency Medical Services-Challenges for the Future.International journal of environmental research and public health · 2023Pooled it
- Non-cancer health risks in firefighters: a systematic review.Epidemiology and health · 2022Pooled it
- Peer delivered, emotion regulation-focused mental health prevention training for fire fighter trainees: Design and methodology of a randomized controlled trial.Contemporary clinical trials communications · 2025Article
- Article
- Firefighter Health: A Narrative Review of Occupational Threats and Countermeasures.Healthcare (Basel, Switzerland) · 2024Review
- An analysis of suicides among first responders ─ Findings from the National Violent Death Reporting System, 2015-2017.Journal of safety research · 2023Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionSuicide claimed 47,173 lives in 2017 and is the second leading cause of death for individuals 15-34 years old. In 2017, rates of suicide in the United States (US) were double the rates of homicide. Despite significant research funding toward suicide prevention, rates of suicide have increased 38% from 2009 to 2017. Recent data suggests that emergency medical services (EMS) workers are at a higher risk of suicidal ideation and suicide attempts compared to the general public. The objective of this study was to determine the proportionate mortality ratio (PMR) of suicide among firefighters and emergency medical technicians (EMT) compared to the general US working population.
methodsWe analyzed over five million adult decedent death records from the National Occupational Mortality Surveillance database for 26 states over a 10-year non-consecutive period including 1999, 2003-2004, and 2007-2013. Categorizing firefighters and EMTs by census industry and occupation code lists, we used the underlying cause of death to calculate the PMRs compared to the general US decedent population with a recorded occupation.
resultsOverall, 298 firefighter and 84 EMT suicides were identified in our study. Firefighters died in significantly greater proportion from suicide compared to the US.working population with a PMR of 172 (95% confidence interval [CI], 153-193, P<0.01). EMTs also died from suicide in greater proportion with an elevated PMR of 124 (95% CI, 99-153), but this did not reach statistical significance. Among all subgroups, firefighters ages 65-90 were found to have the highest PMR of 234 (95% CI, 186-290), P<0.01) while the highest among EMTs was in the age group 18-64 with a PMR of 126 (95% CI, 100-156, P<0.05).
conclusionIn this multi-state study, we found that firefighters and EMTs had significantly higher proportionate mortality ratios for suicide compared to the general US working population. Firefighters ages 65-90 had a PMR more than double that of the general working population. Development of a more robust database is needed to identify EMS workers at greatest risk of suicide during their career and lifetime.
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