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Journal Watch: Protection Against PTSD

Reviewed This Month

The Relationship Between Grit and Resilience in Emergency Medical Service Personnel

Authors: Musso M, Tatum D, Hamer D, Hammarlund R, Son L, McMahon P 

Published in: Ochsner J, 2019 Fall; 19(3): 199–203

Research examining post-traumatic stress disorder (PTSD) among EMS professionals has estimated the rate of PTSD is greater in our profession than in the general public. This is likely not a surprise to anyone reading Journal Watch. Our field providers are regularly exposed to traumatic events, and this includes beyond just providing care in the field. Too many of us have seen colleagues struggle after tough calls, and we have previously discussed how suicide rates in EMS are unacceptably high. Indeed, research has suggested that as many as 80% of EMS providers develop some symptoms of PTSD without developing the full clinical syndrome.   

While the impacts of and risk factors for PTSD have been described in the literature, there are limited studies examining factors that may be protective. Therefore, the authors of the study we review this month sought to examine the relationship among grit, coping mechanisms, demographic variables, professional exposures, and self-reported PTSD symptoms among EMS workers. They define grit as persistence of effort in the face of adversity and passion for long-term goals. Grit has been found to be associated with retention in the military. It has also been associated with lower rates of burnout and greater psychological well-being among medical students. 

While literature evaluating the relationship between grit and resilience is limited, the authors tell us the associations found in previous research may indicate that individuals who have higher grit scores are more resilient. The authors note that resilience enables individuals to overcome obstacles and reach their goals. They hypothesized that EMS professionals who rated themselves higher on a grit scale would report fewer PTSD symptoms, indicating greater resilience to the impact of work-related stressors. 

Surveying the Field

To test their hypothesis, the authors developed and distributed an online survey that assessed the impact of EMS personnel’s work and included questions that examined exposures to traumatic events, PTSD symptoms, and coping mechanisms. They sent a link to the survey to East Baton Rouge Parish (La.) Emergency Medical Services personnel via an e-mail distribution list. The survey was available from June 2017 to August 2017. It included: 

  • A PTSD checklist (PCL-5) that assessed how bothered the individual was by symptoms of PTSD within the past month; 
  • A “grit scale” that assessed consistency of interest and perseverance of effort; 
  • A Brief COPE scale that evaluated self-distraction, active coping, denial, substance abuse, use of emotional support, use of instrumental support, behavioral disengagement, venting, positive reframing, planning, humor, acceptance, religion, and self-blame; 
  • The Professional Exposure to Traumatic Experiences scale, which assessed the frequency of exposure to traumatic events; 
  • Questions about demographics, including race, sex, age, certification level, and years of EMS experience. 

The survey link was e-mailed to 170 EMS professionals, and the analysis was based on 84 individuals with complete data. It indicated there were no demographic or professional exposure variables associated with grit. However, grit scale scores were found to be statistically significant in predicting PCL-5 scores—in fact, they had a negative correlation. In other words, the higher the grit scale score, the less likely individuals were to report being bothered by symptoms of PTSD in the past month. PCL-5 scores also had a statistically significant correlation with items assessed from the Brief COPE scale, including self-distraction, denial, substance abuse, disengagement, venting, and self-blame. 

To further evaluate the relationship between PCL-5 scores, grit, and Brief COPE scale scores, the authors performed multiple regressions. After adjustment the grit scale score’s correlation with reporting being bothered by symptoms of PTSD in the past month remained statistically significant. So did disengagement, self-blame, self-distraction, substance abuse, and denial. 


This is an interesting study because it lets us examine a construct that has not been researched extensively. In fact, the authors say their manuscript is the first to examine the relationship between grit and PTSD symptoms. However, like all research, there are some limitations that contextualize these results. 

The first is the number of questions on this survey. You may have noticed there were four separate scales included in this survey, as well as demographic questions. Those four scales comprised 71 questions—this was a long survey! The length of the survey could partially explain the low response rate. In fact, the authors noted that 108 individuals completed the demographic questions, but their final analysis only included 84 individuals. This is called response fatigue, and it’s a big challenge for survey research. Budding researchers should understand there’s a trade-off in survey research between the amount of information you’d like to obtain and the number of responses that will be returned. 

The authors observed that the study results suggest strategies to increase grit in EMS should be examined. They also suggest it might be wise to screen students’ grit scores. However, it should be noted that the survey was only sent to one EMS agency. These results can’t be generalized to the entire population of EMS professionals. It would be nice to see a similar, but shorter, survey sent to a nationally representative sample to validate these results.

This study highlights the importance of taking care of ourselves. The start of a new year is a great time for EMS professionals to start to think about their own well-being. Rates of PTSD and suicide are much too high in our profession. Please take care of yourselves.   

Antonio R. Fernandez, PhD, NRP, FAHA, is a research scientist at ESO and an assistant professor in the department of emergency medicine at the University of North Carolina–Chapel Hill. He is on the board of advisors of the Prehospital Care Research Forum at UCLA. 

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