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BackgroundAcross Emergency Medical Service (EMS) organisations the high prevalence of poor employee mental health, elevated risk of employee suicide and cultural stigma, bring to the fore the need for tools that enable EMS staff to self-identify, articulate, and disclose their mental wellbeing status.MethodsThe aim of this project was to develop a visual aid, tailored to the EMS sector, to enable ambulance employees to self-identify their own mental wellbeing status. A literature review of available English-language, adult population articles relating to mental health continua in the ambulance context was conducted in July 2021. Electronic databases Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, Epistemenikos, Medline, Prospero, PsycINFO, Scopus and Google Scholar were searched from 2002. Existing mental health continua utilised by EMS organisations were examined and alongside the identified database articles, an expert working group created through stakeholder mapping, debated findings and developed an ambulance specific continuum.ResultsA descriptive narrative of the included studies was produced. Several factors for supporting wellbeing, such as regular eating and sleeping patterns, are not achievable for irregular EMS shift work and would likely create a barrier to participation. Factors such as concise, inclusive, de-stigmatising and appropriate language and taking a holistic view towards employee mental wellbeing were identified as important. A visual four-point continuum of wellbeing consisting of Thriving, surviving, struggling and ‘in crisis’, anchored by five holistic elements of emotional, psychosocial, social, physical wellbeing and addiction was developed. Elements such sleep hygiene moderated by shift work were included. Four suggested supportive techniques are provided to align with the four continuum self-identification points.ConclusionsEvidence suggests that a visual continuum can promote a shared understanding of fluctuating mental health and reduces stigma. Although it is recommended that this tool is disseminated and adopted by EMS, given the lack of validation and evaluation for visual mental health continua identified in the literature, evaluation of adoption, acceptability and effectiveness should be prioritised.

Original publication




Journal article


Emergency Medicine Journal



Publication Date





e5.13 - e5.13