Scientific Reports

Prevention & Management of PTSI in Paramedic Service Organizations: An Environmental Scan of Recommended Programs and Practices

Abstract / Description

Objective

The objective of this environmental scan is to synthesize existing guidelines and recommended practices to prevent and manage work disability related to post-traumatic stress injuries (PTSI) in paramedic service organizations. Findings will contribute to informing the new Canadian Work Disability Management System Standard for Paramedics with a focus on the prevention and management of PTSI and mental illnesses.

Methods

We systematically searched Canadian agency websites for guidelines and resources pertaining to the prevention and management of PTSI in paramedic service organizations. A sample of the websites included in the search are, but not limited to the Paramedic Chiefs of Canada, Paramedic Associations of Canada, provincial paramedic associations, provincial workers’ compensation boards, and health and safety associations. We also supplemented the search results with international resources and resources beyond the scope of paramedic work. From each retrieved resource, we identified programs and practices that could be applied to a work disability management system. The description, rationale, recommended practices, potential barriers to implementation, and any additional relevant information of each program were extracted for synthesis.

Results

A total of 23 guidelines/resources were identified. Six were specific to paramedics, ten were intended for first responders (i.e. police officers, firefighters, and paramedics), and seven were general resources intended for all types of organizations. Our synthesis of these guidelines/resources identifies core programs appropriate for a comprehensive work disability management system for paramedic service organizations with a focus on PTSI, along with their associated recommended practices and potential barriers. The programs are grouped into one of three domains: prevention, early detection and intervention, and disability management.

Prevention

Organizational programs for the prevention of PTSI included stigma reduction initiatives, mental health education and training, and pre-employment screening. Stigma reduction initiatives and mental health education and training play a crucial role in creating the foundation to a psychologically safe and healthy workplace. They help to de-mystify the invisible injury and empower paramedics, supervisors, and friends and family with the appropriate knowledge, skills, and abilities to address PTSI. Further, they reduce paramedics’ fear of being ostracized for seeking help. Paramedic service organizations have also been considering the use of pre-employment screening to identify individuals who are predisposed to developing PTSI. However, there are ethical concerns with pre-employment screening. Rather, more specific and sensitive assessment tools are needed to support paramedic mental health needs.

Early Detection and Intervention

Exposure to traumatic incidences cannot be eliminated in paramedic work; however, the impact of traumatic exposures can be temporary and reversible with early detection and intervention. Organizational programs for the early detection and intervention of PTSI included check-ins after a critical incident, stress leaves, peer support, and employee (and family) assistance programs. Generally, these programs require paramedics to take the initiative to report early signs and symptoms of PTSI and utilize the available resources. This responsibility to self-identify, acknowledge the early signs and symptoms of PTSI, and seek support, reinforces the importance of stigma reduction and education.

Ideally, a work disability management system would also include an in-house mental health professional, a mental health referral network, and/or a substantial extended health plan to reduce barriers to accessing medical assistance. For example, in-house mental health professionals and mental health referral networks help address one of the most significant factors that either contribute to and/or exacerbate mental health challenges among paramedics: the lack of available, qualified mental health professionals and individuals who have been trained to understand the paramedic environment. Such programs also help to address barriers such as costly medical consultations and treatments, as well as long wait times. Disability Management Other recommended disability management programs included medical leaves, return to work and stay at work programs/ planning, and work accommodations. The management of PTSI varies on a case by case basis. However, the core processes and principles to disability management are applicable to all cases. Discussion and Conclusion Our findings suggest that there is a need for PTSI prevention and management programs for all paramedics, regardless of their state of mental health. Prevention programs are intended for all paramedics, including the healthy ones, to develop coping strategies to rebound from psychological hazards and to create a workplace culture that is sensitive to mental health. Paramedics with initial signs and symptoms of PTSI can utilize early detection and intervention programs for the time, space, and/or support needed for emotional processing. If the paramedic has a PTSI that is manageable, there are programs to help them remain at work. Lastly, for paramedics who are suffering from work debilitating PTSI, there are disability management programs to support the paramedic during a sick leave and promote (early) work re-entry. This environmental scan is one of three parts to understanding the state of knowledge and practice towards developing an organizational wide framework for the management of work disability of paramedics with PTSI. Results from the environmental scan will be triangulated with evidence-based practices found in the scientific literature and current and ideal practices to address PTSI identified through key informant interviews.

ACCESSIBLE SKILLED TRADES: INCLUSIVE AND ACCESSIBLE SKILLED TRADES EMPLOYMENT FOR PEOPLE WITH DISABILITIES

Introduction Skilled trades are fundamental to the functioning and growth of Canada’s economy. Workers in trades occupations build infrastructure, maintain essential services, and support industries ranging from construction and manufacturing to transportation and service sec tors. The skilled trades may represent a promising pathway toward equitable employment outcomes for persons with disabilities. Skilled trades careers can provide stable employment, strong earnings potential, and opportunities for advancement. Despite this potential, persons with disabilities remain underrepresented in skilled trades occupations. Research across sectors has documented discrimination in hiring practices, limited opportunities for advancement, and insufficient knowledge among employers regarding disability accommodation. Individuals with disabilities frequently report encountering stigma, aesthetic bias, and skepticism about their productivity or qualifications. In skilled trades environments, these barriers are often amplified by the nature of work tasks and workplace cultures. Trades workplaces often prioritize physical performance, technical skill, and productivity, which can shape assumptions about workers’ abilities and influence access to opportunities. This report addresses knowledge gaps by examining accessibility in skilled trades from multiple complementary perspectives: workers, employers, and previous scientific studies. The projects presented in this report explore employer readiness to accommodate workers with disabilities, the availability of assistive devices, technologies and workplace support solutions, and the lived experiences of persons with disabilities navigating skilled trades employment pathways. Studies contained in this report employ complementary mixed-methods, including phenomenological interviewing, surveys, scoping reviews and environmental scans. Collectively, these findings have direct implications for the development of accessibility standards that reflect the operational, cultural, and safety realities of skilled trades environments. Summary of Findings The research in this report converges on a clear message: persons with disabilities are a significant, underutilized talent pool for Canada’s skilled trades, yet face layered structural, cultural, training, and equipment barriers. Practical, scalable solutions, particularly in training design, PPE and procurement, accommodation pathways, and employer readiness, can meaningfully improve sector entry, safety, and retention. Participation & Risk Persons with disabilities represent about 20% of apprenticeship populations, but remain underrepresented in the broader trades workforce and advancement pathways, across a variety of sources. Apprentices with disabilities reported lower occupational health and safety knowledge, higher likelihood of severe injury, and more chronic and short-term pain, suggesting a preventable gap in training efficacy and workplace controls. Structural & Cultural Barriers Structural obstacles, such as administrative complexity, inconsistent accommodation processes, and certification challenges, limit both access and progression within trades. Cultural dynamics, especially stigma, “old boys’ club” norms, and misconceptions about visible and nonvisible disabilities, shape whether workers disclose, request support, or remain in skilled trades careers. Although participants bring strengths (e.g., problem solving, hyperfocus), deficit-based assumptions often over-shadowed these assets. Disclosure is strategic: workers weigh safety, trust, and anticipated stigma, highlighting the need for transparent, psychologically safe pathways to share their disability. Training & Learning Preferences Hands-on learning was broadly preferred. Apprentices with disabilities consistently recommend accommodations across three themes: learning style, resources, and physical accommodations. PPE Design PPE issues cluster around fit, function, comfort, and sensory load. Poorly designed or ill-fitting PPE can compound disability-related needs and create compatibility conflicts with assistive devices. Employer Readiness & Accommodations Many companies reported being insufficiently prepared to accommodate several impairment types; readiness was lowest for vision and mobility impairments. Construction firms were less prepared than other sectors to accommodate mobility and hearing impairments. Company size matters. Larger organizations showed greater preparedness for mobility and learning-related accommodations, suggesting a resource and capacity gradient. Assistive Technologies & Workplace Solutions Evidence scans show a disproportionate focus on physical impairments, with limited solutions for vision, hearing, and cognitive, needs, where many employers felt least prepared Employers’ awareness and integration of assistive technologies into disability management remain uneven; alignment between solutions and trade-specific tasks or functional demands is critical for adoption and impact. Implications and Next Steps Across all recommendations, a consistent theme emerges: without trade-specific standards, implementation becomes discretionary, inconsistent, and vulnerable to dilution. Employers may struggle to interpret their obligations, workers may experience uneven access to supports, and accountability mechanisms may remain weak. Therefore, trade specific standardization is not merely desirable; it is essential to achieving the objectives of accessibility legislation and ensuring that standards result in real, measurable change in skilled trades workplaces. Conclusions These findings underscore an urgent need to move beyond generalized approaches to accessibility and toward standards that reflect the unique cultures, tasks, and safety realities of skilled trades work. Persistent cultural exclusion, inconsistent employment practices, complex disclosure dynamics, and uneven accommodation access reveal systems that remain misaligned with the lived experiences of workers with disabilities. By applying these findings to standards, Accessibility Standards Canada has a critical opportunity to lead this shift by advancing trade-specific accessibility standards that translate high-level principles into actionable, practical guidance. Without such specificity, implementation risks being fragmented and ineffective. With it, Canada can meaningfully expand equitable participation in the skilled trades, strengthen workforce resilience, and build inclusive trades systems capable of meeting the country’s future social and economic needs. View French Publication

Scientific Reports 2025

The Level of Perceived Occupational Health and Safety Knowledge in Skilled Trades Apprentices: Impact, Influencing factors, and Learning Preferences

Introduction Canada’s skilled trades shortage has negatively impacted organizations and consumers and has cost billions of dollars from healthcare expenditure and productivity loss. This issue is compounded by the high risk of disabling injury to workers in the skilled trades, particularly apprentices. While occupational health and safety (OHS) training may improve health and safety outcomes in theory, we must emphasize the appropriate delivery of OHS content to better suit skilled trades apprentices. It may be possible to maximize the impact of OHS training by first understanding how apprentices perceive their current training. The findings presented in this study improves on the current understanding of the potential links between a skilled trades apprentice’s perceptions and preferences of their OHS training, and their injury outcomes. Through effective delivery of OHS training, including considerations of apprentice preferences, we may be able to maximize the retention of health and safety information and contribute towards the development of a safer workforce. Objectives We aim to explore the relationships between a skilled trades apprentice's perception of their OHS knowledge and their self-reported physical and cognitive demands. This report also aims to explore the relationship between a skilled trades apprentice's self-reported functional limitations and their knowledge acquisition. Finally, we seek a better understanding of an apprentice’s preferred delivery method when learning about OHS. Key Findings An apprentice with a lower self-perception of their OHS knowledge was also more likely to report a negative OHS outcome. Inexperienced apprentices that have a lower self perceived knowledge in their OHS training were also more likely to report that they had sustained an injury over a 12-month period. There were also relationships between an apprentice’s self-perceived knowledge of health and safety, and the self-reporting of feeling burned out and overwhelmed. The program release type, age, and level of an apprentice influenced their perceived OHS confidence and subsequent relationship with injury and pain self reporting. Day release apprentices were 1.5 times more likely to self-report an injury, while younger apprentices perceived themselves as more confident than older apprentices but were twice as likely to self-report an injury. Older apprentices, while less likely to self-report an injury, were 1.24 times more likely to report non-injury related body pain. There was a greater self-reporting of cognitive functional limitations compared to physical functional limitations (e.g. walking). While apprentices with these functional limitations overall perceived that they were unaffected by them, trends indicated that these apprentices perceived themselves as less likely to be able to manage their own safety, and the safety of their coworkers. This may indicate that apprentices with functional limitations may not be fully aware of the underlying impacts of their functional limitations on their work ability, including their ability to implement their OHS training. Hands-on training was overwhelmingly preferred by apprentices as a means of improving the retention of information and improving the situational awareness that would otherwise be underdeveloped through traditional classroom lectures. A combination of receiving foundational OHS training through their apprenticeship training and workplace specific OHS training from the employer may improve an apprentice’s ability to identify and manage OHS hazards. Practical Implications We may be able to improve an apprentice’s OSH outcomes by improving their confidence in their OSH training. However, a confident apprentice is not necessarily a safe apprentice, as that confidence must be proportional to their OHS knowledge. Apprentices will benefit from receiving hands-on OHS training that is directly aligned with the most relevant workplace hazards. This requires that the apprentice receive not only foundational OHS knowledge in the classroom, but also more specific, situationally relevant training from their employer. If implemented correctly, OHS training may facilitate a reduction in workplace injuries and MSD development through the application of well-retained and relevant OHS knowledge.

Scientific Reports 2025

Landscape of Experiential Learning Technologies for Teaching Occupational Health and Safety in Skilled Trades

Background and Objective Injuries and illnesses among skilled trades professions accounted for over 25% of all workers’ compensation claims in Ontario between 2015 and 2020. Ensuring that skilled trade professionals are equipped with the relevant occupational safety and health (OSH) knowledge, skills, and abilities is critical in mitigating occupational risks and reducing injuries. Low engagement during OSH training has been the primary reason for low retention of OSH-related knowledge; thus, skilled trade professionals and trainees must receive effective and engaging OSH training to ensure that the knowledge is learned, retained, and applied. Experiential learning technologies (ELTs) (e.g., immersive virtual reality (VR) experiences, simulators, and interactive and serious games) can increase engagement, and knowledge and skills retention when compared to traditional classroom PowerPoint lectures. Given that ELTs may be a powerful tool for teaching OSH, we aim to build an ELT toolbox to support OSH training in the skilled trades. As a first step in developing an ELT toolbox, we conducted an environmental scan to better understand the existing OSH-related ELTs that are commercially available for trainees and professionals working in the skilled trades. Methods A systematic web-based search was performed to obtain existing commercially available OSH-related ELTs for the skilled trades; snowballing technique was applied to identify additional results. Key information was extracted from each relevant ELT, including the description of the ELT and its intended occupation, the tasks performed in the ELT, and the OSH topics taught. Software developers who only offered customized ELT solutions were also documented. Key Findings ➢ 288 off-the-shelf OSH-related ELTs for skilled trade occupations were identified. Over 50 complimentary ELTs (nearly 20%) can be delivered via highly accessible platforms such as desktops or smartphones. ➢ 85 unique off-the-shelf ELT developers/distributors were identified. 65% of the off-the-shelf ELT developers’/distributors’ headquarters were in the USA; 11% were in Canada. More ELTs need to be developed in Canada or have options to be customized to Canadian safety laws and regulations. ➢ 10 different types of delivery mechanisms for OSH-related ELTs emerged. Most of the ELTs are delivered through VR headsets, meaning that, if trainees have access to a VR headset, they can access a vast library of OSH-related ELTs. ➢ 96 unique topic areas were identified. Thirteen topics were relevant to general skilled trades, 3 were relevant to the service sector, 3 for the automotive sector, 32 for the industrial sector, and 45 for the construction sector. Many of the ELTs identified were relevant to acute injury prevention while few focused on the chronic and long-term consequences of hazardous exposures. ELTs designed for trade-specific occupations (n=192) often focused on the safe work processes and practices of a given task (e.g., painting, welding, machine operations, gas leak inspection) with the integration of OSH concepts. ➢ 42 software developers who only offered customized ELT solutions were identified.