When Enzo Plaitano became an emergency medical technician (EMT) at age 16, he never imagined he’d someday play a leading role in helping to improve the health and wellness of emergency medical services (EMS) clinicians across the U.S.
“When I was in high school, I joined my local ambulance service as a way for me to give back to people and have some positive impact in my community.” recalls Plaitano. “Now ten years in and as a licensed paramedic, I still find it extremely rewarding to provide care to people in their greatest time of need.”
However, through his lived experiences as a paramedic, Plaitano has become acutely aware of the unique challenges confronting those working in his profession. EMS clinicians are repeatedly placed in isolated and unpredictable situations with only an ambulance and limited equipment, personnel, and medical oversight to care for patients. These work-related factors put them at higher risk for chronic stress, mental health problems, and substance use.
“I came to Dartmouth to work with world-class experts at the Center for Technology and Behavioral Health (CTBH). The center’s mission is to design digital health interventions to help ameliorate mental health and substance use problems. I knew they could teach me how to develop tools to better support our vulnerable but essential EMS clinicians,” explains Plaitano, who is now a third-year PhD candidate in the CTBH at Dartmouth’s Geisel School of Medicine. In Plaitano’s recent study, 86% of EMS clinicians said they would try using a digital health tool designed for stress management if it were available.
With this in mind, Plaitano is now the principal investigator of a federal grant from the National Institute on Drug Abuse and the CTBH Pilot Grant Program to build upon this work and start informing the development of his health app. He has established core collaborations and support from mentors across Dartmouth and other prominent organizations such as the National Registry of EMTs, the National Center for PTSD, and the National Association of EMTs.
Earlier this year, he and his team launched an innovative, intensive longitudinal study to understand the relationships between stress, emotion-regulation, and health risk behaviors in the daily lives of EMS clinicians nationally. Their goal was to use data to inform the development of a digital health application designed to help EMS clinicians manage job stress.
For this study, they screened more than 2,000 EMS clinicians from across the U.S. for eligibility. In just a few months, Plaitano enrolled their target number of 110 full-time EMS clinicians across 33 states. Using a personalized text message system, participants completed multiple short surveys each day for a month. The surveys were sent to their smartphones, providing real-time data on changes in their stress levels, emotion-regulation, and substance use risks.
The team has finished collecting all of their data, including more than 12,200 individual surveys from the 110 EMS clinicians. “I’m excited that we’re in the data analysis phase where we can start to uncover what to include in our future intervention. It’s truly an app designed for EMS clinicians, by EMS clinicians,” says Plaitano, whose ultimate goal is to develop an app for better stress management that is easy to use, confidential, and broadly accessible. “We have a lot of stigma surrounding mental health in EMS. It’s hard to admit that you’re not okay when you’re always supposed to be the one helping other people,” said Plaitano. “This might be one solution to help support my peers.”
The app could allow EMS clinicians to monitor their stress levels in real time and then provide immediate resources for healthy coping strategies. “These immediate and easily accessible resources may be better than waiting until we get home after our shifts to try to cope with the extreme difficulties of the job,” he says. “Our goal is to use this data provided from EMS clinicians to create a tool to help them manage their stressors in a more adaptive and healthy way.”
