Table 5 Actions to support their strategy that employers should consider include

Develop a strategy for supporting the wellbeing, psychosocial care and mental health of their staff. Staff should be aware of the existence of this strategy and should have access to it

Review how pre-hospital trainees are selected and allocated to placements with a view to reducing secondary stressors

Address the expected working patterns and geographical locations of trainees and working sites to minimise secondary stresses which result from long hours, long commutes, separation from friends and families and disruption of carer responsibilities

Promote research to gain knowledge of the scale and impact of the exposure of their staff to distress arising from their work

Promote awareness of the emotional labour ordinarily carried out by their staff and of ways to cope with it. A substantial amount of emotional labour is implicitly required by pre-hospital healthcare professionals who regularly support patients and their families through great suffering and the most distressing events

Promote knowledge of the evidence showing that responders are likely to be at risk of the psychosocial and mental health consequences of their involvement in significant incidents

Promote awareness of the evidence showing that employees gain psychosocial benefits from knowing that their employer has a strategy in place to support their psychosocial and mental health and that employees who are well supported tend to make fewer mistakes