Closing the Gap Between Need and Care: Predictors of Mental Health Service Use in EMS

Background: Emergency medical services (EMS) personnel experience high rates of psychological distress yet demonstrate low utilization of mental health services. Factors associated with actual service use—rather than intentions or attitudes—are not well understood. Methods: Using secondary data from 36,697 licensed Florida EMTs and paramedics collected during the 2022 licensure renewal process, logistic regression models evaluated the relative contributions of workplace factors, attitudinal variables, trauma exposure, and mental health symptoms in their association with service utilization. Results: Psychological symptoms, particularly anxiety and depression, were the strongest factors associated with help-seeking. Peer support emerged as one of the few system-level factors associated with increased service use, even after accounting for symptom presence. Stigma-related variables showed weaker and, in some cases, counterintuitive associations. Suicidality and substance use were modestly associated with help-seeking beyond core symptom variables. Findings were consistent among trauma-exposed personnel. Discussion: Results are consistent with the potential value of early identification, routine symptom screening, and integrated, system-level supports such as peer support and access to confidential, occupationally competent care.