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TABLE 4 Childhood Trauma Profile of EMS Professionals Stratified of model variance, ∆R = .146, ∆F (5,62) = 3.31, p = .010. In

by Prior Military Service Compared to the Overall Sample total, these predictors accounted for 45.4% of the variance in
Civilian EMS Military NSS IESR total score, R = .454, adjusted R = .321, F (15,62) =
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496 (64.4%) 61 (71.8%) 187 (24.3%) 3.43, p < .001.
n (%) n (%) n (%)
Physical abuse 116 (23.4%) 29 (32.6%) 32 (17.1%) Squared semipartial correlations were used to identify the
Emotional abuse 162 (32.7%) 37 (41.6%) 39 (20.85%) unique predictive utility of independent variables. Sex alone
Sexual abuse 74 (14.9%) 14 (15.7%) 21 (11.2%) accounted for 5.9% (sr = .059, p = .012) of model variance,
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Physical neglect 36 (7.3%) 6 (6.7%) 4 (2.1%) while shift length accounted for an additional 4.1% (sr =
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Emotional neglect 116 (23.4%) 17 (19.1%) 18 (9.6%) .041, p = .036). The potential presence of cumulative stress
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Parental divorce 221 (44.6%) 44 (49.4%) 82 (43.8%) syndromes, such as VT or BO, accounted for 7.8% (sr = .078,
Maternal domestic 57 (11.5%) 13 (14.6%) 10 (5.3%) p = .004) and 4.0% (p = .037), respectively. When military
violence variables were assessed, neither military experience nor a his-
Substance abuse in 159 (32.1%) 26 (29.2%) 34 (18.1%) tory of a combat deployment was significant. However, per-
the home forming combat patrols or other dangerous duties during a
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Familial depression, deployment did account for 6.6% (sr = .066, p = .008) of the
mental illness, or 142 (28.6%) 26 (29.2%) 24 (12.8%) model variance, while the number of years of military service
suicide accounted for 6.1% (sr = .061, p = .011) of the variance in
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Incarcerated family the IESR total score. There were also negative associations:
member 38 (7.7%) 8 (9.0%) 9 (4.8%) for every added year of age or total years of military service,
Continuous Variables Mean ± SD Mean ± SD Mean ± SD the total IESR score was reduced by 0.48 and 1.07 points,
ACEs total score 2.26 ± 2.29 2.47 ± 2.27 1.46 ± 1.78 respectively. Sex was also negatively associated in that females
NSS = no stress syndrome; ACEs = Adverse Childhood Experiences had, on average, scores that were nearly 12 points lower than
Questionnaire. their male counterparts, which could be the result of several
factors. Namely, there was a low number of female veterans
enrolled in the study. Because of the timing of service, the ma-
syndrome compared to those without—ratios similar to that jority of female prior Servicemembers were not in positions of
of EMS professionals in general (Figure 2). Notwithstanding offensive or defensive combat arms—a procedural change that
the presence of stress syndromes, when veterans were com- did not occur until 2015. In the final model, these five pre-
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pared to their civilian EMS peers, the rates of events that they dictors accounted for a significant portion of unique criterion
had experienced directly were almost always higher in the variance.
population of EMS personnel with prior military history.
Discussion
Predictive Utility of Prior Military Service
Hierarchical linear regression was performed to ascertain the Nearly three-quarters of the EMS personnel with prior mili-
predictive utility of military experience in EMS personnel with tary service surveyed as part of this study scored high enough
VT. VT was used because, as a primary stress syndrome, it to have a stress syndrome, which was a 7.4% relative increase
most closely resembles PTSD—the most frequently diagnosed compared to a similarly employed group of nonmilitary EMS
mental health issue among OIF/OEF veterans. Table 6 shows personnel.
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the variables entered into the final regression model and
unique criterion variance.
Impact of Adverse Childhood Experiences
Collinearity statistics, including tolerance and variance infla- The ACEs questionnaire was used to quantify the presence of
tion factor (VIF), were all within accepted limits, indicating childhood trauma and evaluates childhood trauma material in
that the assumption of multicollinearity had been met. Histo- ten categories: physical, emotional, or sexual abuse; physical
grams, residuals, and scatter plots indicated that the assump- or emotional neglect; domestic violence; substance abuse; his-
tions of normality, linearity, and homoscedasticity were all tory of depression, mental illness, or suicide within the family;
satisfied, respectively. parental divorce; and whether any member of the household
was incarcerated. There is an association between scores on
On block 1, sociodemographic variables, such as age, sex, and the ACEs and reduced life expectancy or impaired physical and
minority status accounted for 3.5% of the variance in IESR mental health. 32–34 Individuals with scores ≥ 4 are 12.2 times
total score, R = .035, F (3,74) = .904, p = .443. When occu- more likely to ever attempt suicide. 35,36 Overall, 26 (29.2%)
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pational characteristics (shift length, annual income, and years veterans had scores ≥ 4; however, when the sample was nar-
of field experience) were entered on block 2, they accounted rowed down to veterans who likely had stress syndromes or
for an additional, but not statistically significant, 4.8% of the in female veterans alone, the prevalence increased by 5.2%
variance in total IESR score, ∆R = .048, ∆F (3,71) = 1.25, p = and 20.8%, respectively. Mean total scores were highest in the
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.381. Suicidality, knowing an EMS provider who had commit- veteran population when compared to nonmilitary EMS per-
ted suicide, and the presence of CF or BO as characteristics in- sonnel and to those without any stress syndrome.
dicative of stress were entered on block 3 and accounted for an
additional and significant 22.4% of the model variance, ∆R
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= .224, ∆F (4,67) = 5.42, p = .001. Military characteristics, in- Suicidality and the Potential for Contagion
cluding years of service, prior history of a combat deployment, When evaluating the likelihood of any stress syndrome, EMS
prior history of combat patrols or other dangerous duty, and personnel with prior military service had higher rates of
engagement of the enemy accounted for an additional 14.6% prior counseling for stress-related events when compared to

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